=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871451526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANSELM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2026
-----------------------------------------------------
Last Update Date | 01/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 WATER ST
-----------------------------------------------------
City | WILKES BARRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18702-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-829-7742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 EMERALD DR
-----------------------------------------------------
City | THROOP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18512-3349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-730-9797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW026619
-----------------------------------------------------
License Number State |
-----------------------------------------------------