Provider Demographics
NPI:1841565983
Name:DIMMIG, RANA N (LCSW)
Entity Type:Individual
Prefix:
First Name:RANA
Middle Name:N
Last Name:DIMMIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6311
Mailing Address - Country:US
Mailing Address - Phone:610-861-8779
Mailing Address - Fax:610-861-4677
Practice Address - Street 1:308 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6311
Practice Address - Country:US
Practice Address - Phone:610-861-8779
Practice Address - Fax:610-861-4677
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125268104100000X
PACW0197571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103416617-0002Medicaid
PA103416617-0001Medicaid