Provider Demographics
NPI:1952300915
Name:KROHN, MARY W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:W
Last Name:KROHN
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 1:200 NORTH 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:1733 PENN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19609-2054
Practice Address - Country:US
Practice Address - Phone:610-670-7270
Practice Address - Fax:610-678-3825
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0140111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW014011OtherLICENSE
PA038911LRRMedicare ID - Type Unspecified
PACW014011OtherLICENSE