Provider Demographics
NPI:1972652105
Name:ANDERSON-KRIEG, SUSAN J (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:ANDERSON-KRIEG
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:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:SCOTRUN
Mailing Address - State:PA
Mailing Address - Zip Code:18355-0325
Mailing Address - Country:US
Mailing Address - Phone:570-688-2929
Mailing Address - Fax:570-688-0022
Practice Address - Street 1:601 SCOTRUN AVE
Practice Address - Street 2:
Practice Address - City:SCOTRUN
Practice Address - State:PA
Practice Address - Zip Code:18355-9663
Practice Address - Country:US
Practice Address - Phone:570-688-2929
Practice Address - Fax:570-688-0022
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0126241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical