Healthcare Provider Details

I. General information

NPI: 1780684266
Provider Name (Legal Business Name): DWIGHT L KLOPP LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 CUMBERLAND STREET
LEBANON PA
17042-5232
US

IV. Provider business mailing address

200 N 7TH ST
LEBANON PA
17046-5040
US

V. Phone/Fax

Practice location:
  • Phone: 717-274-2741
  • Fax: 717-274-5405
Mailing address:
  • Phone: 717-273-1710
  • Fax: 717-273-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013147
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: