Provider Demographics
NPI:1982990701
Name:BOOKWALTER, LAINE MERI (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:LAINE
Middle Name:MERI
Last Name:BOOKWALTER
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:MISS
Other - First Name:LAINE
Other - Middle Name:MERI
Other - Last Name:MCCULLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:276 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-2532
Mailing Address - Country:US
Mailing Address - Phone:814-657-1542
Mailing Address - Fax:
Practice Address - Street 1:20231 PAINT BLVD
Practice Address - Street 2:
Practice Address - City:SHIPPENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16254-4625
Practice Address - Country:US
Practice Address - Phone:814-226-1159
Practice Address - Fax:814-227-2876
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128692104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker