Provider Demographics
NPI:1477653905
Name:ATWELL, KATHLEEN C (LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:ATWELL
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 3RD AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5816
Mailing Address - Country:US
Mailing Address - Phone:570-283-1600
Mailing Address - Fax:570-283-5515
Practice Address - Street 1:400 3RD AVE STE 211
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5816
Practice Address - Country:US
Practice Address - Phone:570-283-1600
Practice Address - Fax:570-283-5515
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW002234L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA440013OtherFIRST PRIORITY HEALTH #
PA62-64071OtherUNITED HEALTHCARE #
PA440013OtherFIRST PRIORITY HEALTH #