Provider Demographics
NPI:1275164055
Name:STANZIALE, PAUL THOMAS (LSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:STANZIALE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDREN'S SERVICE CENTER
Mailing Address - Street 2:335 S. FRANKLIN ST.
Mailing Address - City:WILKES-BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701
Mailing Address - Country:US
Mailing Address - Phone:570-825-6425
Mailing Address - Fax:570-829-3337
Practice Address - Street 1:CHILDREN'S SERVICE CENTER
Practice Address - Street 2:335 S. FRANKLIN ST.
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701
Practice Address - Country:US
Practice Address - Phone:570-825-6425
Practice Address - Fax:570-829-3337
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW008857L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker