Provider Demographics
NPI:1578927174
Name:BOETTCHER, MEGAN ROSE (LCSW, C-SSWS, DCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ROSE
Last Name:BOETTCHER
Suffix:
Gender:F
Credentials:LCSW, C-SSWS, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 TULIP CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2134
Mailing Address - Country:US
Mailing Address - Phone:570-815-6681
Mailing Address - Fax:570-341-9736
Practice Address - Street 1:324 TULIP CIR
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2134
Practice Address - Country:US
Practice Address - Phone:570-815-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0189991041C0700X
MD182091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical