Provider Demographics
NPI:1467518068
Name:BLEWITT, CHARLES G (EDD LCSW)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:BLEWITT
Suffix:
Gender:M
Credentials:EDD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 MORGAN HIGHWAY
Mailing Address - Street 2:ADVANCED COMMUNITY SERVICE
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508
Mailing Address - Country:US
Mailing Address - Phone:570-207-7919
Mailing Address - Fax:570-963-1953
Practice Address - Street 1:475 MORGAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508
Practice Address - Country:US
Practice Address - Phone:570-207-7919
Practice Address - Fax:570-963-1953
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000196L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
640369FXNMedicare ID - Type Unspecified