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General NPI Number Information
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NPI Number | 1023439221
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Entity Type | Individual
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Provider Name | JESSICA ELIZABETH DIMOFF QUERRY LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1225 WARM SPRINGS AVE
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City | HUNTINGDON
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State | PA
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Zip | 16652-2350
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Country | US
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Telephone | 814-643-8149
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Fax |
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Provider Business Mailing Address
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Address Line | 15313 HARES VALLEY RD
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City | MAPLETON DEPOT
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State | PA
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Zip | 17052-9521
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Country | US
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Telephone | 814-386-3222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW019336
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License Number State | PA
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