Healthcare Provider Details

I. General information

NPI: 1588823926
Provider Name (Legal Business Name): JOANNE MARION JUDGE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 PITTSTON AVE SUITE 7
SCRANTON PA
18505-2964
US

IV. Provider business mailing address

3218 PITTSTON AVE SUITE 7
SCRANTON PA
18505-2964
US

V. Phone/Fax

Practice location:
  • Phone: 570-558-1303
  • Fax: 570-558-1304
Mailing address:
  • Phone: 570-558-1303
  • Fax: 570-558-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW123898
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: