Provider Demographics
NPI:1821668591
Name:EMMANOUILIDES, SANDRA MADELEINE (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MADELEINE
Last Name:EMMANOUILIDES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MADELEINE
Other - Last Name:ENCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 E SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19070-2123
Mailing Address - Country:US
Mailing Address - Phone:215-681-1813
Mailing Address - Fax:
Practice Address - Street 1:36 E FRONT ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2936
Practice Address - Country:US
Practice Address - Phone:215-681-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0257711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical