Provider Demographics
NPI:1467885046
Name:MUMMAU, KAREN A (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:MUMMAU
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 1:1987 STATE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1324
Mailing Address - Country:US
Mailing Address - Phone:717-333-0436
Mailing Address - Fax:
Practice Address - Street 1:1987 STATE ST STE 207
Practice Address - Street 2:
Practice Address - City:EAST PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520-1324
Practice Address - Country:US
Practice Address - Phone:717-333-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125121104100000X
PACW0191081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker