Healthcare Provider Details

I. General information

NPI: 1033464144
Provider Name (Legal Business Name): JEREMY H NORMAN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MARKET ST
NEW BERLIN PA
17855-8050
US

IV. Provider business mailing address

406 MARKET ST PO BOX 505
NEW BERLIN PA
17855-8050
US

V. Phone/Fax

Practice location:
  • Phone: 570-898-5457
  • Fax:
Mailing address:
  • Phone: 570-898-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW123158
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: