Provider Demographics
NPI:1922724434
Name:BORTZ, DANA LYN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYN
Last Name:BORTZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-1204
Mailing Address - Country:US
Mailing Address - Phone:610-704-6175
Mailing Address - Fax:
Practice Address - Street 1:4250 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-1204
Practice Address - Country:US
Practice Address - Phone:610-704-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0170961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical