Healthcare Provider Details

I. General information

NPI: 1891080735
Provider Name (Legal Business Name): MARIETTE CECILE SERVAIS JUMET MSW/LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIETTE CECILE SERVAIS JUMET

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 INTERSTATE PKWY
BRADFORD PA
16701-1013
US

IV. Provider business mailing address

159 INTERSTATE PKWY
BRADFORD PA
16701-1013
US

V. Phone/Fax

Practice location:
  • Phone: 814-362-8480
  • Fax:
Mailing address:
  • Phone: 814-362-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW129156
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: