Provider Demographics
NPI:1619951183
Name:GOTWALS, ELIZABETH T (MSW,LCSW,ACSW,QCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:T
Last Name:GOTWALS
Suffix:
Gender:F
Credentials:MSW,LCSW,ACSW,QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PEACH ORCHARD ROAD
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233
Mailing Address - Country:US
Mailing Address - Phone:717-485-6120
Mailing Address - Fax:717-485-6106
Practice Address - Street 1:214 PEACH ORCHARD ROAD
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233
Practice Address - Country:US
Practice Address - Phone:717-485-6120
Practice Address - Fax:717-485-6106
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACWO136171041C0700X
PACW013617104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018117730001Medicaid
PA0018117730004Medicaid
PA0018117730004Medicaid
G0035580Medicare UPIN