=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215379318
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES OWEN RIMEL JR. MSW, LSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2013
-----------------------------------------------------
Last Update Date | 05/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4309 LINGLESTOWN RD STE 214
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17112-8607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-412-4908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5001 MAURETANIA AVE
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17109-5531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-579-5462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW128542
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------