Healthcare Provider Details

I. General information

NPI: 1720377682
Provider Name (Legal Business Name): PATRICIA BUBERNIAK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 LIBERTY ST
PERRYOPOLIS PA
15473-0717
US

IV. Provider business mailing address

PO BOX 717
PERRYOPOLIS PA
15473-0717
US

V. Phone/Fax

Practice location:
  • Phone: 724-628-3435
  • Fax: 724-628-3440
Mailing address:
  • Phone: 724-736-0129
  • Fax: 724-628-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW127420
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: