Provider Demographics
NPI:1780684266
Name:KLOPP, DWIGHT L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:L
Last Name:KLOPP
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 1:200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-5040
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:618 CUMBERLAND STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5232
Practice Address - Country:US
Practice Address - Phone:717-274-2741
Practice Address - Fax:717-274-5405
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0131471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS11153Medicare ID - Type Unspecified
PA812839LS5Medicare ID - Type Unspecified