Healthcare Provider Details

I. General information

NPI: 1285357491
Provider Name (Legal Business Name): STEPHANIE SEYMOUR MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE KEATING

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 N WASHINGTON AVE STE 104
SCRANTON PA
18503-1511
US

IV. Provider business mailing address

375 LAKE SPANGENBERG RD
JEFFERSON TOWNSHIP PA
18436-5000
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-3361
  • Fax: 570-961-3364
Mailing address:
  • Phone: 570-290-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW133796
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: