Provider Demographics
NPI:1083799563
Name:STAUB, CARLA REED (LICENSED CERTIFIED C)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:REED
Last Name:STAUB
Suffix:
Gender:F
Credentials:LICENSED CERTIFIED C
Other - Prefix:MRS
Other - First Name:CARLA
Other - Middle Name:REED
Other - Last Name:STAUB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:9 FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:MCSHERRYSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17344-1130
Mailing Address - Country:US
Mailing Address - Phone:717-637-1040
Mailing Address - Fax:
Practice Address - Street 1:129 CHARLES ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1807
Practice Address - Country:US
Practice Address - Phone:717-524-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000166L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1083799563OtherSOUTH CENTRAL PREFERRED
PA1083799563OtherWELLSPAN
PA1083799563OtherMEDICARE
PA1083799563OtherBLUE SHIELD
PA02831600OtherCAPITAL BLUE CROSS
PA1083799563OtherUNITED BEHAVIORAL HEALTH