Provider Demographics
NPI:1033464144
Name:NORMAN, JEREMY H (MSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:H
Last Name:NORMAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MARKET ST
Mailing Address - Street 2:PO BOX 505
Mailing Address - City:NEW BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17855-8050
Mailing Address - Country:US
Mailing Address - Phone:570-898-5457
Mailing Address - Fax:
Practice Address - Street 1:406 MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17855-8050
Practice Address - Country:US
Practice Address - Phone:570-898-5457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1231581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical