MEDICARE: THERESA EUGENIA LASCALA 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	CW016188	PA

General Provider Information

NPI Number	:	1710110549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA EUGENIA LASCALA LCSW

Provider Business Mailing Address
First Line	:	1851 W END AVE
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-2050
Country	:	US
Telephone Number	:	570-622-9102
Fax Number	:	570-773-3520

Provider Business Practice Location Address
First Line	:	1851 W END AVE
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-2050
Country	:	US
Telephone Number	:	570-622-9102
Fax Number	:	570-773-3520

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

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	08/27/2009

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