Healthcare Provider Details

I. General information

NPI: 1033284047
Provider Name (Legal Business Name): MARY ANNA NAMIOTKA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S CENTRE AVE SUITE 203
LEESPORT PA
19533-8653
US

IV. Provider business mailing address

105 N WATER ST
WOMELSDORF PA
19567-1334
US

V. Phone/Fax

Practice location:
  • Phone: 610-743-0771
  • Fax: 610-743-8402
Mailing address:
  • Phone: 610-743-0771
  • Fax: 610-743-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014737
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: