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General NPI Number Information
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NPI Number | 1740669019
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Entity Type | Organization
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Legal Business Name | LAURIE E ETZRODT
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 301 OXFORD VALLEY RD 304A
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City | YARDLEY
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State | PA
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Zip | 19067-7706
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Country | US
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Telephone | 215-493-8896
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Fax | 215-340-1867
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Provider Business Mailing Address
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Address Line | 301 OXFORD VALLEY RD 304A
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City | YARDLEY
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State | PA
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Zip | 19067-7706
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Country | US
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Telephone | 215-493-8896
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Fax | 215-340-1867
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURIE E ETZRODT
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Credential | MSS,LCSW
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Telephone | 215-493-8896
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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 | CWO14488
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License Number State | PA
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