Provider Demographics
NPI:1275554461
Name:METTLER, LUCIA A (MSS/LSW)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:A
Last Name:METTLER
Suffix:
Gender:F
Credentials:MSS/LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 CLIVEDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3510
Mailing Address - Country:US
Mailing Address - Phone:215-869-5414
Mailing Address - Fax:
Practice Address - Street 1:7401 OLD YORK RD
Practice Address - Street 2:CARRIAGE HOUSE
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3005
Practice Address - Country:US
Practice Address - Phone:215-869-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014596104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker