Healthcare Provider Details

I. General information

NPI: 1194356477
Provider Name (Legal Business Name): MARIA KOLCHARNO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S WASHINGTON AVE
JERMYN PA
18433-1121
US

IV. Provider business mailing address

501 S WASHINGTON AVE
SCRANTON PA
18505-3814
US

V. Phone/Fax

Practice location:
  • Phone: 570-955-7821
  • Fax:
Mailing address:
  • Phone: 570-955-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW128193
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: