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General NPI Number Information
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NPI Number | 1689210684
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Entity Type | Individual
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Provider Name | COLLEEN RECKLESS LSW
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Gender | Female
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 1300 OLD PLANK RD
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City | MAYFIELD
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State | PA
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Zip | 18433-1973
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Country | US
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Telephone | 570-281-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 31 CHRISTY LN
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City | SCOTT TOWNSHIP
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State | PA
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Zip | 18447-7723
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Country | US
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Telephone | 570-575-2312
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW021521
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 127222
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License Number State | PA
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