Provider Demographics
NPI:1649612805
Name:PANE, EDWARD A (CSW)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:PANE
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W BROAD ST STE 308
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6427
Mailing Address - Country:US
Mailing Address - Phone:570-436-7022
Mailing Address - Fax:570-534-0997
Practice Address - Street 1:8 W BROAD ST
Practice Address - Street 2:SUITE 308
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6424
Practice Address - Country:US
Practice Address - Phone:570-436-7022
Practice Address - Fax:580-534-0997
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129221104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW129221OtherSOCIAL WORKER
PA0231OtherCERTIFIED ADVANCED ALCOHOL AND DRUG COUNSELOR