Provider Demographics
NPI:1689210684
Name:RECKLESS, COLLEEN (LSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:RECKLESS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:BRYDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:31 CHRISTY LN
Mailing Address - Street 2:
Mailing Address - City:SCOTT TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18447-7723
Mailing Address - Country:US
Mailing Address - Phone:570-575-2312
Mailing Address - Fax:
Practice Address - Street 1:1300 OLD PLANK RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:PA
Practice Address - Zip Code:18433-1973
Practice Address - Country:US
Practice Address - Phone:570-281-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0215211041C0700X
PA127222104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker