Gina Weidow, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW026013 Issued in PA

Practice address

1169 Wyoming Ave
Forty Fort, PA 18704-4003

Phone

(570) 904-7363

Fax

(570) 227-1591

NPI assigned

Aug 20, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Thaxton Holistic Wellness Center

  • Professional Counselor
  • Scranton, PA
  • NPI 1609243898
  NPD (past)

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

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1679185565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 S MAIN AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185042545",
            "telephone_number": "570-904-7363",
            "fax_number": "570-348-4079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1169 WYOMING AVE",
            "city": "FORTY FORT",
            "state": "PA",
            "postal_code": "187044003",
            "telephone_number": "570-904-7363",
            "fax_number": "570-227-1591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIDOW",
        "first_name": "GINA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-20",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW026013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph P Vavrek, HEARING AID FITTER
• Allyson Nichole Villella
• Vision Innovation Centers of PA LLC
• Jamie Lee Walker, AUD
• Mary A Walters, DC
• Wilkes Barre Home Care Services LLC (Commonwealth Home Health & Hospice of Wilkes-Barre)
• Wilkes Barre Home Care Services LLC (Commonwealth Home Health & Hospice of Wilkes-Barre)
• William H Boyle, MD PC
• Erin Williams, MS, NCC, LPC
• Emily Witts

• Clinical Social Worker in Forty Fort, PA
• Providers in Forty Fort, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.