Provider Demographics
NPI:1720377682
Name:BUBERNIAK, PATRICIA (LSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BUBERNIAK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473-0717
Mailing Address - Country:US
Mailing Address - Phone:724-736-0129
Mailing Address - Fax:724-628-3440
Practice Address - Street 1:395 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473-0717
Practice Address - Country:US
Practice Address - Phone:724-628-3435
Practice Address - Fax:724-628-3440
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127420104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker