Provider Demographics
NPI:1467456905
Name:LOTSPEICH, MARY TATE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:TATE
Last Name:LOTSPEICH
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 1:210 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1518
Mailing Address - Country:US
Mailing Address - Phone:570-523-0601
Mailing Address - Fax:570-523-1701
Practice Address - Street 1:32 WHISPER CREEK DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7770
Practice Address - Country:US
Practice Address - Phone:570-523-0601
Practice Address - Fax:570-523-1701
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW003978L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0659161Medicare ID - Type Unspecified