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General NPI Number Information
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NPI Number | 1104901032
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Entity Type | Individual
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Provider Name | TINA ARENDASH LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 179 S WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704-3405
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Country | US
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Telephone | 570-285-8025
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Fax | 570-696-4361
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Provider Business Mailing Address
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Address Line | 28 SYCAMORE DR
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City | DRUMS
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State | PA
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Zip | 18222-2049
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Country | US
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Telephone | 570-599-5918
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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 | CW019092
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License Number State | PA
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