Healthcare Provider Details

I. General information

NPI: 1154681237
Provider Name (Legal Business Name): JOANNE STORER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 RT. 390 HIGHPOINT BUSINESS CENTER
MOUNTAINHOME PA
18342
US

IV. Provider business mailing address

PO BOX 41
MOUNTAINHOME PA
18342-0041
US

V. Phone/Fax

Practice location:
  • Phone: 570-595-0950
  • Fax: 570-595-0528
Mailing address:
  • Phone: 570-595-0950
  • Fax: 570-595-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014950
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOANNE STORER
Title or Position: OWNER
Credential: LCSW
Phone: 570-595-0950