Provider Demographics
NPI:1235883877
Name:DEREWICZ, ANNA ROSE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ANNA ROSE
Middle Name:MARIE
Last Name:DEREWICZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNA ROSE
Other - Middle Name:MARIE
Other - Last Name:MATWEECHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:11 LAZY LN APT 204
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-2807
Mailing Address - Country:US
Mailing Address - Phone:570-956-6624
Mailing Address - Fax:
Practice Address - Street 1:11 LAZY LN APT 20411
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-2723
Practice Address - Country:US
Practice Address - Phone:570-956-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional