Provider Demographics
NPI:1164433801
Name:PISTNER, NANCY JOAN (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JOAN
Last Name:PISTNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JOAN
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-0130
Mailing Address - Country:US
Mailing Address - Phone:570-505-9670
Mailing Address - Fax:
Practice Address - Street 1:226 ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1404
Practice Address - Country:US
Practice Address - Phone:570-505-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0172941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
033249OtherANTHEM BCBS
1032906OtherCIGNA
ME128490200Medicaid
7576313OtherAETNA
139202OtherVALUE OPTIONS
110048OtherTEAMSTERS BEL HEALTH NNEB
291554000OtherMAGELLAN
7576313OtherAETNA