Healthcare Provider Details

I. General information

NPI: 1164433801
Provider Name (Legal Business Name): NANCY JOAN PISTNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY JOAN WALTERS LCSW

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 ALLEGHENY ST
JERSEY SHORE PA
17740-1404
US

IV. Provider business mailing address

PO BOX 130
JERSEY SHORE PA
17740-0130
US

V. Phone/Fax

Practice location:
  • Phone: 570-505-9670
  • Fax:
Mailing address:
  • Phone: 570-505-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017294
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: