Sandra Davis Chisholm, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

077669 Issued in NY

Practice address

6185 Whitetail Dr
Coopersburg, PA 18036-9581

Phone

(610) 745-9136

NPI assigned

Sep 25, 2007

Last updated

Feb 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Inner Resources Counseling Inc

  • Psychologist
  • Bethlehem, PA
  • NPI 1255771739
  NPD (past)
• The Fifth Avenue Counseling Center, Inc.

  • Community/Behavioral Health Agency
  • New York, NY
  • NPI 1801037270
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1356538219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6185 WHITETAIL DR",
            "city": "COOPERSBURG",
            "state": "PA",
            "postal_code": "180369581",
            "telephone_number": "610-745-9136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6185 WHITETAIL DR",
            "city": "COOPERSBURG",
            "state": "PA",
            "postal_code": "180369581",
            "telephone_number": "610-745-9136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "807 W Broad St",
            "address_purpose": "LOCATION",
            "city": "Bethlehem",
            "state": "PA",
            "postal_code": "180185223",
            "country_code": "US",
            "telephone_number": "610-745-9136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHISHOLM",
        "first_name": "SANDRA",
        "middle_name": "DAVIS",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-25",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "077669",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "017925",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nina Yvonne Britz, M.S., OTR/L
• Sonja Burmeister, OTR/L
• George Lee Carey III, MS
• Philip Joseph Castellani, DC
• Children's Therapy Services
• Anthony P Colasurdo, D.C.
• Patricia Colasurdo, D.C.
• Coopersburg Dental PLLC
• Coopersburg EMS
• Coopersburg Family Chiropractic LLC

• Social Worker in Coopersburg, PA
• Providers in Coopersburg, PA by specialty
• Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.