Healthcare Provider Details

I. General information

NPI: 1063411429
Provider Name (Legal Business Name): JANE L THURSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

IV. Provider business mailing address

176 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-5208
  • Fax: 724-770-7914
Mailing address:
  • Phone: 724-775-5208
  • Fax: 724-770-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLC2319
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: