Provider Demographics
NPI:1285790923
Name:SCHANTZENBACH, WAYNE R (LCSW, LMFT)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:R
Last Name:SCHANTZENBACH
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-2111
Mailing Address - Country:US
Mailing Address - Phone:610-282-2575
Mailing Address - Fax:610-282-3076
Practice Address - Street 1:343 S 3RD ST
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2111
Practice Address - Country:US
Practice Address - Phone:610-282-2575
Practice Address - Fax:610-282-3076
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACS-004706-E1041C0700X
PAMF-000119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist