Provider Demographics
NPI:1982002960
Name:DEETERS, CAREY (LCSW)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:DEETERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 COVEDALE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16693-7224
Mailing Address - Country:US
Mailing Address - Phone:814-330-5781
Mailing Address - Fax:
Practice Address - Street 1:9528 LINCOLN HWY STE 1
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3764
Practice Address - Country:US
Practice Address - Phone:814-623-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0209121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical