Healthcare Provider Details

I. General information

NPI: 1356501761
Provider Name (Legal Business Name): AMY J VRESCAK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

IV. Provider business mailing address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333
UM

V. Phone/Fax

Practice location:
  • Phone: 724-632-5828
  • Fax: 724-632-3198
Mailing address:
  • Phone: 724-632-5828
  • Fax: 724-632-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: