Healthcare Provider Details

I. General information

NPI: 1740106004
Provider Name (Legal Business Name): NICOLE H LITOSTANSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N LAUREL ST
HAZLETON PA
18201-5948
US

IV. Provider business mailing address

20 N LAUREL ST
HAZLETON PA
18201-5948
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-0082
  • Fax:
Mailing address:
  • Phone: 570-459-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW123355
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: