Provider Demographics
NPI:1356080212
Name:ANNEMARIE RICH, LCSW COUNSELING SERVICES
Entity Type:Organization
Organization Name:ANNEMARIE RICH, LCSW COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-887-2350
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:SMETHPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16749-0332
Mailing Address - Country:US
Mailing Address - Phone:814-887-2350
Mailing Address - Fax:814-887-2084
Practice Address - Street 1:203 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMETHPORT
Practice Address - State:PA
Practice Address - Zip Code:16749-1259
Practice Address - Country:US
Practice Address - Phone:814-887-2350
Practice Address - Fax:814-887-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102923463Medicaid