Provider Demographics
NPI:1053477364
Name:METROPOULOS, GEORGANN (LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGANN
Middle Name:
Last Name:METROPOULOS
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 1:100 PLAZA CT STE D
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8258
Mailing Address - Country:US
Mailing Address - Phone:570-424-6763
Mailing Address - Fax:570-424-9352
Practice Address - Street 1:100 PLAZA CT STE D
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8258
Practice Address - Country:US
Practice Address - Phone:570-424-6763
Practice Address - Fax:570-424-9352
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW009373L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW009373LOtherLICENSE NUMBER