Provider Demographics
NPI:1720110505
Name:CIOTOLA, LIA MARIE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:LIA
Middle Name:MARIE
Last Name:CIOTOLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W BROAD STREET
Mailing Address - Street 2:SUITE 412 413
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201
Mailing Address - Country:US
Mailing Address - Phone:570-454-0334
Mailing Address - Fax:570-454-2534
Practice Address - Street 1:101 W BROAD STREET
Practice Address - Street 2:SUITE 412 413
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201
Practice Address - Country:US
Practice Address - Phone:570-454-0334
Practice Address - Fax:570-454-2534
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0120131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA804745OtherFIRST PRIORITY HEALTH OF
PA804745OtherFIRST PRIORITY HEALTH OF