Provider Demographics
NPI:1861646077
Name:CUVA-PRIMMER, JAN KAREN (LSW)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:KAREN
Last Name:CUVA-PRIMMER
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 1:1258 PURDYTOWN TPKE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18438-6793
Mailing Address - Country:US
Mailing Address - Phone:570-226-1963
Mailing Address - Fax:
Practice Address - Street 1:1258 PURDYTOWN TPKE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18438-6793
Practice Address - Country:US
Practice Address - Phone:570-226-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126654104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker