Provider Demographics
NPI:1710063524
Name:VAN SCOY, GARY (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:VAN SCOY
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 LAIRD ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18705-3818
Mailing Address - Country:US
Mailing Address - Phone:570-826-0999
Mailing Address - Fax:570-208-0603
Practice Address - Street 1:111 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1401
Practice Address - Country:US
Practice Address - Phone:570-826-0999
Practice Address - Fax:570-208-0603
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2010-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001159L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical