Edward Alfred Thiry III, LSW, CAC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

SW125058 Issued in PA

Practice address

4845 W Lake Rd
Suite 120
Erie, PA 16505-2973

Phone

(814) 528-5323

NPI assigned

Aug 23, 2010

Sex

Male

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283126400000",
    "number": "1750697256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4845 W LAKE RD",
            "address_2": "SUITE 120",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165052973",
            "telephone_number": "814-528-5323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4845 W LAKE RD",
            "address_2": "SUITE 120",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165052973",
            "telephone_number": "814-528-5323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIRY",
        "first_name": "EDWARD",
        "middle_name": "ALFRED",
        "name_suffix": "III",
        "credential": "LSW, CAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-23",
        "last_updated": "2010-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW125058",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "PA",
            "license": "5918",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; 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.