Provider Demographics
NPI:1104863513
Name:RIEGEL, AMI LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMI
Middle Name:LYNN
Last Name:RIEGEL
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 1:15 HILLSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972
Mailing Address - Country:US
Mailing Address - Phone:570-640-3744
Mailing Address - Fax:
Practice Address - Street 1:396 S. CENTRE STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901
Practice Address - Country:US
Practice Address - Phone:570-640-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013192L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10129699500Medicaid
PA045227Medicare UPIN