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NPI Code Detail

MEDICARE: PAUL ANTHONY CLEMENTS L.C.S.W.

MEDICARE: PAUL ANTHONY CLEMENTS L.C.S.W.
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 WorkerCW-015096PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
150054663OTHERPACAPITAL BLUE CROSS
21782446OTHERPAPA BLUE SHIELD

General Provider Information

NPI Number : 1306881743
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL ANTHONY CLEMENTS L.C.S.W.
Provider Business Mailing Address
First Line : 1017 SHANNON LN
Second Line :
City : CARLISLE
State : PA
Zip : 17013-1782
Country : US
Telephone Number : 717-254-1976
Fax Number : 717-258-3158
Provider Business Practice Location Address
First Line : 47 W POMFRET ST
Second Line :
City : CARLISLE
State : PA
Zip : 17013-3217
Country : US
Telephone Number : 717-258-0214
Fax Number : 717-258-3158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 07/08/2007

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