Provider Demographics
NPI:1649241126
Name:STUMP, ERNEST L (LCSW)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:L
Last Name:STUMP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HOWARD AVE
Mailing Address - Street 2:STE F2
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4899
Mailing Address - Country:US
Mailing Address - Phone:814-946-2701
Mailing Address - Fax:814-946-7864
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:STE F2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4899
Practice Address - Country:US
Practice Address - Phone:814-946-2701
Practice Address - Fax:814-946-7864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker