Basic Information
Provider Information | |||||||||
NPI: | 1801849864 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WORRALL | ||||||||
FirstName: | STEPHANIE | ||||||||
MiddleName: | MICHELLE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FARMER | ||||||||
OtherFirstName: | STEPHANIE | ||||||||
OtherMiddleName: | MICHELLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 200 NORTH 7TH ST | ||||||||
Address2: |   | ||||||||
City: | LEBANON | ||||||||
State: | PA | ||||||||
PostalCode: | 17046 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172731710 | ||||||||
FaxNumber: | 7172731416 | ||||||||
Practice Location | |||||||||
Address1: | 938 PENN ST | ||||||||
Address2: |   | ||||||||
City: | READING | ||||||||
State: | PA | ||||||||
PostalCode: | 19609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6104788088 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/18/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | CW014883 | PA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.