Provider Demographics
NPI:1326114836
Name:WELLER, MARY RITA (EDD LSW)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:RITA
Last Name:WELLER
Suffix:
Gender:F
Credentials:EDD LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565
Mailing Address - Country:US
Mailing Address - Phone:610-678-7186
Mailing Address - Fax:
Practice Address - Street 1:122 W LANCASTER AVE
Practice Address - Street 2:SUITE 01
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1881
Practice Address - Country:US
Practice Address - Phone:610-775-1878
Practice Address - Fax:610-777-1295
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW009517L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical