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General NPI Number Information
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NPI Number | 1588948467
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Entity Type | Individual
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Provider Name | MIRIAM INEZ HARTLEY MSW/LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 1124 TWIN STACKS DR
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City | DALLAS
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State | PA
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Zip | 18612-8505
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Country | US
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Telephone | 570-674-1155
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Fax | 570-674-1156
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Provider Business Mailing Address
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Address Line | 3154 MEMORIAL HWY STE 100
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City | DALLAS
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State | PA
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Zip | 18612-9203
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Country | US
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Telephone | 570-674-1155
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Fax | 570-674-1156
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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 | SW128734
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW017835
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License Number State | PA
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