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General NPI Number Information
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NPI Number | 1346674975
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Entity Type | Individual
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Provider Name | MICHELLE BACKUS MSW
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Gender | Female
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Dates
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Enumeration Date | 08/30/2013
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 633 LAKESIDE DRIVE
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City | TOBYHANNA
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State | PA
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Zip | 18466
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Country | US
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Telephone | 866-992-9143
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 329
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City | MOUNT POCONO
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State | PA
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Zip | 18344-0329
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Country | US
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Telephone | 570-972-5939
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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 |
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License Number State |
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