Healthcare Provider Details

I. General information

NPI: 1699087056
Provider Name (Legal Business Name): PETER JAMES DUNFORD L.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 JEFFERSON AVE SUITE 204
SCRANTON PA
18510-1630
US

IV. Provider business mailing address

615 JEFFERSON AVE SUITE 204
SCRANTON PA
18510-1630
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-1186
  • Fax: 570-344-7641
Mailing address:
  • Phone: 570-344-1186
  • Fax: 570-344-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW011129L
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: