MEDICARE: JENNIFER M GOETZ MSW, LSW, RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SW141549	PA
2	183500000X	Pharmacist	RP044828L	PA

General Provider Information

NPI Number	:	1790077998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M GOETZ MSW, LSW, RPH

Provider Business Mailing Address
First Line	:	1501 SCALP AVE
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-3308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 BEDFORD ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-1424
Country	:	US
Telephone Number	:	814-659-1137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	05/29/2024

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