Provider Demographics
NPI:1285357491
Name:SEYMOUR, STEPHANIE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:375 LAKE SPANGENBERG RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-5000
Mailing Address - Country:US
Mailing Address - Phone:570-290-6173
Mailing Address - Fax:
Practice Address - Street 1:327 N WASHINGTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1511
Practice Address - Country:US
Practice Address - Phone:570-961-3361
Practice Address - Fax:570-961-3364
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133796104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty