MEDICARE: MRS. KATHRYN ELLER 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
1	1041C0700X	Clinical Social Worker	CW022906	PA

General Provider Information

NPI Number	:	1376255885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN ELLER LCSW

Provider Business Mailing Address
First Line	:	3326 GLENWOOD PARK AVE
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16508-2717
Country	:	US
Telephone Number	:	570-772-2798
Fax Number	:

Provider Business Practice Location Address
First Line	:	3326 GLENWOOD PARK AVE
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16508-2717
Country	:	US
Telephone Number	:	570-772-2798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2022
Last Update Date	:	12/15/2022

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