Provider Demographics
NPI:1982257887
Name:DOUGLAS, CATHERINE (LSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4101 BIRNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1323
Mailing Address - Country:US
Mailing Address - Phone:570-961-3361
Mailing Address - Fax:570-961-3364
Practice Address - Street 1:189 MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5400
Practice Address - Country:US
Practice Address - Phone:570-961-3361
Practice Address - Fax:570-961-3364
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129457104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker