Healthcare Provider Details

I. General information

NPI: 1306556048
Provider Name (Legal Business Name): JAY A. WORLEY LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 N BROMLEY AVE
SCRANTON PA
18504-1503
US

IV. Provider business mailing address

827 N BROMLEY AVE
SCRANTON PA
18504-1503
US

V. Phone/Fax

Practice location:
  • Phone: 570-589-4405
  • Fax:
Mailing address:
  • Phone: 570-589-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136707
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: