Gloria M Wellbrock, LCSW
Individual provider Active NPI Clinical Social Worker · Lords Valley, PA
NPI 1760618219 · NPPES record last updated Sep 10, 2021
Key facts
- NPI
- 1760618219
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- CW021503 (PA)
- Practice address
- 110 Hemlock Farms Rd Ste 7
Lords Valley, PA 18428-6133 - Phone
- (646) 236-2534
- NPI assigned
- Jun 10, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
110 Hemlock Farms Rd
Suite 7
Lords Valley, PA 18428-6133
Phone (646) 236-2534
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210819002022 | PA | Practitioner - Clinical Social Worker | 5294889911 | Practice locations: Lords Valley, PA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 076627-1 | NY | MD | Clinical Social Worker |
| CW021503 | PA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 076627-1 | NY | |
| Clinical Social Worker | 1041C0700X | CW021503 | PA | Yes |
Addresses
Primary practice location
110 Hemlock Farms Rd Ste 7
Lords Valley, PA 18428-6133
Mailing address
110 Hemlock Farms Rd
Lords Valley, PA 18428-6145
Phone (646) 236-2534
Other practice location 1
31 Kirby Ct
Staten Island, NY 10301-1210
Phone (646) 236-2534
Other providers in Lords Valley, PA
- Tigue Chiropractic Inc
- Lynnita M Tigue-Petroski
- Christine Trusky
- Wayne Memorial Community Health Centers
- Tori K Welch
All providers in Lords Valley, PA · Clinical Social Worker in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.