Provider Demographics
NPI:1043340490
Name:WAKS, BETH W (MSW)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:W
Last Name:WAKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CHINABERRY DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2321
Mailing Address - Country:US
Mailing Address - Phone:610-420-6374
Mailing Address - Fax:610-832-9387
Practice Address - Street 1:466 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1805
Practice Address - Country:US
Practice Address - Phone:610-420-6374
Practice Address - Fax:610-832-9387
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW008558L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker