Provider Demographics
NPI:1649608290
Name:MARIA T. MYERS, LCSW, LLC
Entity type:Organization
Organization Name:MARIA T. MYERS, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:717-480-1002
Mailing Address - Street 1:2793 OLD POST RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3683
Mailing Address - Country:US
Mailing Address - Phone:717-480-1002
Mailing Address - Fax:717-412-7136
Practice Address - Street 1:2793 OLD POST RD
Practice Address - Street 2:SUITE 11
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3683
Practice Address - Country:US
Practice Address - Phone:717-480-1002
Practice Address - Fax:717-412-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0145811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100919Medicare Oscar/Certification