Healthcare Provider Details

I. General information

NPI: 1942929914
Provider Name (Legal Business Name): AMY AVILLION LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 03/31/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S. WASHINGTON AVE
SCRANTON PA
18505
US

IV. Provider business mailing address

425 S FRANKLIN ST APT 16
WILKES BARRE PA
18702-3843
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-5550
  • Fax:
Mailing address:
  • Phone: 570-574-4432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW140501
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: