Provider Demographics
NPI:1063570711
Name:FRONTZ, ELIZABETH JANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JANE
Last Name:FRONTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:WEEDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15868-3100
Mailing Address - Country:US
Mailing Address - Phone:814-787-5211
Mailing Address - Fax:814-787-5211
Practice Address - Street 1:204 ABBEY RD
Practice Address - Street 2:
Practice Address - City:WEEDVILLE
Practice Address - State:PA
Practice Address - Zip Code:15868-3100
Practice Address - Country:US
Practice Address - Phone:814-787-5211
Practice Address - Fax:814-787-5211
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001817898OtherKEYSTONE WEST
PA563144OtherVALUE OPTIONS
PA1012467600003Medicaid