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NPI Code Detail

MEDICARE: NEIL PETROSKY LCSW

MEDICARE: NEIL PETROSKY LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCW018342PA

General Provider Information

NPI Number : 1093106635
Entity Type Code : Individual
Provider Name (Legal Business Name) : NEIL PETROSKY LCSW
Provider Business Mailing Address
First Line : 601 PARK ST
Second Line :
City : HONESDALE
State : PA
Zip : 18431-1445
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 750 ROUTE 739
Second Line :
City : LORDS VALLEY
State : PA
Zip : 18428-6058
Country : US
Telephone Number : 570-775-4081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2015
Last Update Date : 02/17/2015

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Directions to “ NEIL PETROSKY LCSW” Practice Location

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