Provider Demographics
NPI:1316004427
Name:DITTMAR, ANN S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:S
Last Name:DITTMAR
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 1:4963 ROUTE 30
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2343
Mailing Address - Country:US
Mailing Address - Phone:724-610-7726
Mailing Address - Fax:724-420-5739
Practice Address - Street 1:4963 ROUTE 30
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2343
Practice Address - Country:US
Practice Address - Phone:724-610-7726
Practice Address - Fax:724-420-5739
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW006295L1041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007610520008Medicaid
PA390219Medicare ID - Type UnspecifiedPROVIDER NUMBER