Provider Demographics
NPI:1912081910
Name:VON HENDY, FRANK M (LSW)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:M
Last Name:VON HENDY
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:FRANCIS
Other - Middle Name:M
Other - Last Name:VON HENDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:126 GULICK ST
Mailing Address - Street 2:
Mailing Address - City:BLOSSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16912-1002
Mailing Address - Country:US
Mailing Address - Phone:570-638-3425
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1803
Practice Address - Country:US
Practice Address - Phone:570-265-2525
Practice Address - Fax:570-265-1075
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW008282L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
679845Medicare ID - Type Unspecified