Provider Demographics
NPI:1467528810
Name:ANDEREGG, ANNE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:ANDEREGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1358
Mailing Address - Country:US
Mailing Address - Phone:570-723-0620
Mailing Address - Fax:570-724-0675
Practice Address - Street 1:520 RUAH STREET
Practice Address - Street 2:
Practice Address - City:BLOSSBURG
Practice Address - State:PA
Practice Address - Zip Code:16912
Practice Address - Country:US
Practice Address - Phone:570-638-1260
Practice Address - Fax:570-638-2065
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0160151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical