Healthcare Provider Details

I. General information

NPI: 1740811942
Provider Name (Legal Business Name): ALLISON LEIGH DABBACK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COMMERCE PARK DR STE 110
WILLIAMSPORT PA
17701-5475
US

IV. Provider business mailing address

PO BOX 597
MOUNTVILLE PA
17554-0597
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-6944
  • Fax: 570-323-4529
Mailing address:
  • Phone: 717-285-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136841
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: