Provider Demographics
NPI:1093085540
Name:WINGER, EBONY L (LSW)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:L
Last Name:WINGER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 BARKEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-7902
Mailing Address - Country:US
Mailing Address - Phone:724-992-9931
Mailing Address - Fax:
Practice Address - Street 1:456 N PITT ST
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-1129
Practice Address - Country:US
Practice Address - Phone:724-662-7202
Practice Address - Fax:724-662-7208
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128530101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health