Healthcare Provider Details

I. General information

NPI: 1548685449
Provider Name (Legal Business Name): JENNIFER RARICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W CATAWISSA ST
NESQUEHONING PA
18240
US

IV. Provider business mailing address

801 OSTRUM ST ENROLLMENT CENTER
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 570-669-9787
  • Fax: 570-669-9785
Mailing address:
  • Phone: 484-526-8046
  • Fax: 833-213-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019614
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: