MEDICARE: NANCY JEAN REDETZKY L.S.W., M.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
1	104100000X	Social Worker	SW006967L	PA

General Provider Information

NPI Number	:	1568814614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY JEAN REDETZKY L.S.W., M.S.W.

Provider Business Mailing Address
First Line	:	1200 LINE ST
Second Line	:
City	:	ARCHBALD
State	:	PA
Zip	:	18403-1918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 LINE ST
Second Line	:
City	:	ARCHBALD
State	:	PA
Zip	:	18403-1918
Country	:	US
Telephone Number	:	570-876-9200
Fax Number	:

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

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	07/12/2016

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