Provider Demographics
NPI:1033284047
Name:NAMIOTKA, MARY ANNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNA
Last Name:NAMIOTKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-1334
Mailing Address - Country:US
Mailing Address - Phone:610-743-0771
Mailing Address - Fax:610-743-8402
Practice Address - Street 1:5 S CENTRE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8653
Practice Address - Country:US
Practice Address - Phone:610-743-0771
Practice Address - Fax:610-743-8402
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0147371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical