Provider Demographics
NPI:1376283663
Name:PANOWICZ, TAMARA (NCC, MED)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:PANOWICZ
Suffix:
Gender:F
Credentials:NCC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:LARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1402
Mailing Address - Country:US
Mailing Address - Phone:570-793-9108
Mailing Address - Fax:
Practice Address - Street 1:480 PIERCE ST STE 108
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5512
Practice Address - Country:US
Practice Address - Phone:570-855-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health