Provider Demographics
NPI:1326794249
Name:MULLINS, ELISE (LSW)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 FOUNDRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-5900
Mailing Address - Country:US
Mailing Address - Phone:570-855-0535
Mailing Address - Fax:
Practice Address - Street 1:106 E FRONT ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4818
Practice Address - Country:US
Practice Address - Phone:570-961-3361
Practice Address - Fax:570-961-3364
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130841104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker