Provider Demographics
NPI:1093772949
Name:HALL, MARYANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:HALL
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 1:115 CROWN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2002
Mailing Address - Country:US
Mailing Address - Phone:570-963-5872
Mailing Address - Fax:
Practice Address - Street 1:1615 E ELM ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3925
Practice Address - Country:US
Practice Address - Phone:570-342-8305
Practice Address - Fax:570-344-1178
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW009582L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health