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General NPI Number Information
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NPI Number | 1134734932
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Entity Type | Individual
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Provider Name | LANELLE QUZACK LSW
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Gender | Female
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 704 14TH AVE
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City | PROSPECT PARK
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State | PA
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Zip | 19076-1207
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Country | US
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Telephone | 267-977-0618
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Fax |
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Provider Business Mailing Address
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Address Line | 310 N MATLACK ST
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City | WEST CHESTER
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State | PA
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Zip | 19380-2620
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Country | US
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Telephone | 610-696-4900
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW137290
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License Number State | PA
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