Provider Demographics
NPI:1629462775
Name:FRATARCANGELO, JOHNNA (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:
Last Name:FRATARCANGELO
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 1:1418 MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2050
Mailing Address - Country:US
Mailing Address - Phone:570-277-1123
Mailing Address - Fax:
Practice Address - Street 1:1418 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2050
Practice Address - Country:US
Practice Address - Phone:570-277-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131497104100000X
PACW0204521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker