Provider Demographics
NPI:1952405110
Name:NASH, JEANNE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:H
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:1258 PURDYTOWN TPKE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18438-6793
Mailing Address - Country:US
Mailing Address - Phone:570-226-1963
Mailing Address - Fax:570-226-1967
Practice Address - Street 1:1258 PURDYTOWN TPKE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18438-6793
Practice Address - Country:US
Practice Address - Phone:570-226-1963
Practice Address - Fax:570-226-1967
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0185231041C0700X
PACW0121601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA352744SM7Medicare PIN
NYNGZG9Medicare ID - Type Unspecified