Provider Demographics
NPI:1497074348
Name:DOCHSTADER, BEVERLY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:DOCHSTADER
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:ST. JAMES & THIRD STREET
Mailing Address - Street 2:SUITE 103S
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933
Mailing Address - Country:US
Mailing Address - Phone:570-662-7600
Mailing Address - Fax:570-662-7726
Practice Address - Street 1:ST. JAMES & THIRD STREET
Practice Address - Street 2:SUITE 103S
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933
Practice Address - Country:US
Practice Address - Phone:570-662-7600
Practice Address - Fax:570-662-7726
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0145891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical