Healthcare Provider Details

I. General information

NPI: 1568814614
Provider Name (Legal Business Name): NANCY JEAN REDETZKY L.S.W., M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LINE ST
ARCHBALD PA
18403-1918
US

IV. Provider business mailing address

1200 LINE ST
ARCHBALD PA
18403-1918
US

V. Phone/Fax

Practice location:
  • Phone: 570-876-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW006967L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: