Doctor Name: | JENNIFER J ERVINE |
NPI Number: | 1790705895 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | CW015081 |
Business Practice Address: | 110 South Pennsylvania Avenue Wilkes-barre, PA - 187013301 |
Business Phone Number: | 5705523900 |
Business Fax Number: | 5705523907 |
Mailing Address: | 110 South Pennsylvania Avenue, WILKES-BARRE |
State: | PA |
Postal Code: | 187013301 |
Phone Number: | 5705523900 |
Fax Number: | 5705523907 |
NPI Enumeration Date: | 07/20/2006 |
NPI Last Update Date: | 08/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | CW015081 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |