Provider Demographics
NPI:1194356477
Name:KOLCHARNO, MARIA (LSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KOLCHARNO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3814
Mailing Address - Country:US
Mailing Address - Phone:570-955-7821
Mailing Address - Fax:
Practice Address - Street 1:5 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JERMYN
Practice Address - State:PA
Practice Address - Zip Code:18433-1121
Practice Address - Country:US
Practice Address - Phone:570-955-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128193104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker