Provider Demographics
NPI:1154681237
Name:JOANNE STORER
Entity type:Organization
Organization Name:JOANNE STORER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STORER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-595-0950
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINHOME
Mailing Address - State:PA
Mailing Address - Zip Code:18342-0041
Mailing Address - Country:US
Mailing Address - Phone:570-595-0950
Mailing Address - Fax:570-595-0528
Practice Address - Street 1:1056 RT. 390 HIGHPOINT BUSINESS CENTER
Practice Address - Street 2:
Practice Address - City:MOUNTAINHOME
Practice Address - State:PA
Practice Address - Zip Code:18342
Practice Address - Country:US
Practice Address - Phone:570-595-0950
Practice Address - Fax:570-595-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0149501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty