Provider Demographics
NPI:1891223079
Name:WINDEMAKER, SAGE (LCSW)
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:
Last Name:WINDEMAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN UNIVERSITY
Mailing Address - State:PA
Mailing Address - Zip Code:19352-8920
Mailing Address - Country:US
Mailing Address - Phone:717-364-0385
Mailing Address - Fax:
Practice Address - Street 1:330 KENNETT PIKE STE 205B
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-8217
Practice Address - Country:US
Practice Address - Phone:717-364-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0192731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical