Provider Demographics
NPI:1740581859
Name:SWITZER, TYSON (LISW)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:SWITZER
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WHISPER CREEK DR STE 7
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7770
Mailing Address - Country:US
Mailing Address - Phone:570-522-0304
Mailing Address - Fax:570-522-0475
Practice Address - Street 1:32 WHISPER CREEK DR STE 7
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7770
Practice Address - Country:US
Practice Address - Phone:570-522-0304
Practice Address - Fax:570-522-0475
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW018602104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074575Medicaid