Provider Demographics
NPI:1336147370
Name:TINSLEY, RITA M (LCSW)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:TINSLEY
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 1:1141 CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1191
Mailing Address - Country:US
Mailing Address - Phone:570-558-0555
Mailing Address - Fax:570-558-0777
Practice Address - Street 1:1141 CLAY AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18510-1191
Practice Address - Country:US
Practice Address - Phone:570-558-0555
Practice Address - Fax:570-558-0777
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001101L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
638123Medicare UPIN
638123Medicare PIN