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NPI Code Detail

MEDICARE: MRS. MARY ELLEN MORAN DOLL LSW

MEDICARE: MRS. MARY ELLEN MORAN DOLL LSW
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
1104100000XSocial WorkerSW123579PA

General Provider Information

NPI Number : 1457392169
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ELLEN MORAN DOLL LSW
Provider Business Mailing Address
First Line : 66 OVERLOOK DR
Second Line :
City : DANVILLE
State : PA
Zip : 17821-9616
Country : US
Telephone Number : 570-271-1807
Fax Number : 570-322-8026
Provider Business Practice Location Address
First Line : 435 W 4TH ST
Second Line :
City : WILLIAMSPORT
State : PA
Zip : 17701-6001
Country : US
Telephone Number : 570-322-7873
Fax Number : 570-322-8026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 07/08/2007

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