Provider Demographics
NPI:1619444635
Name:JENNIFER ZELEWICZ LCSW LLC
Entity Type:Organization
Organization Name:JENNIFER ZELEWICZ LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:570-419-5435
Mailing Address - Street 1:16425 ROUTE 42
Mailing Address - Street 2:
Mailing Address - City:EAGLES MERE
Mailing Address - State:PA
Mailing Address - Zip Code:17731
Mailing Address - Country:US
Mailing Address - Phone:570-419-5435
Mailing Address - Fax:570-525-3389
Practice Address - Street 1:REAR 1012 WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3684
Practice Address - Country:US
Practice Address - Phone:570-419-5435
Practice Address - Fax:570-525-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112794Medicaid