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General NPI Number Information
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NPI Number | 1144511783
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Entity Type | Organization
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Legal Business Name | CLINICAL SOCIAL WORKER ASSOCIATES, INC.
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Dates
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Enumeration Date | 05/01/2011
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 396 S. CENTRE STREET
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City | POTTSVILLE
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State | PA
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Zip | 17901-3655
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Country | US
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Telephone | 570-640-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 899 WYNONAH DR
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City | AUBURN
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State | PA
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Zip | 17922-9214
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Country | US
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Telephone | 570-640-3744
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MRS. AMI LYNN RIEGEL
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Credential | MSW
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Telephone | 570-640-3744
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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 | CW013192L
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License Number State | PA
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