Provider Demographics
NPI:1588822043
Name:ASENDORF, JAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:ASENDORF
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 1:1611 PEACH ST
Mailing Address - Street 2:SUITE 185
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2109
Mailing Address - Country:US
Mailing Address - Phone:814-480-8985
Mailing Address - Fax:
Practice Address - Street 1:1611 PEACH ST
Practice Address - Street 2:SUITE 185
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2109
Practice Address - Country:US
Practice Address - Phone:814-480-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0163171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical