Provider Demographics
NPI:1164417663
Name:SERBIN, CAROLE CLOWSER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:CLOWSER
Last Name:SERBIN
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 1:290 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3764
Mailing Address - Country:US
Mailing Address - Phone:814-341-4389
Mailing Address - Fax:724-801-8153
Practice Address - Street 1:290 GRANT ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3764
Practice Address - Country:US
Practice Address - Phone:814-341-4389
Practice Address - Fax:724-801-8153
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001067E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
604488Medicare ID - Type UnspecifiedGROUP
PA443018Medicare ID - Type Unspecified