Healthcare Provider Details

I. General information

NPI: 1578927174
Provider Name (Legal Business Name): MEGAN ROSE BOETTCHER LCSW, C-SSWS, DCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 TULIP CIR
CLARKS SUMMIT PA
18411-2134
US

IV. Provider business mailing address

324 TULIP CIR
CLARKS SUMMIT PA
18411-2134
US

V. Phone/Fax

Practice location:
  • Phone: 570-815-6681
  • Fax:
Mailing address:
  • Phone: 570-815-6681
  • Fax: 570-341-9736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018999
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: