Provider Demographics
NPI:1588948467
Name:HARTLEY, MIRIAM INEZ (MSW/LCSW)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:INEZ
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MSW/LCSW
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:INEZ
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW/LCSW
Mailing Address - Street 1:3154 MEMORIAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9203
Mailing Address - Country:US
Mailing Address - Phone:570-674-1155
Mailing Address - Fax:570-674-1156
Practice Address - Street 1:1124 TWIN STACKS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-8505
Practice Address - Country:US
Practice Address - Phone:570-674-1155
Practice Address - Fax:570-674-1156
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128734104100000X
PACW0178351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker