Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | SW129268 | PA |
Y | 1041C0700X | Clinical Social Worker | CW018007 | PA |
NPI | 1003242348 |
---|---|
Provider Name | Michelle Reed Straub |
First Address | Kersey, PA 15846-2912 |
Second Address | Saint Marys, PA 15857-2827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2013 |
Last Update Date | 09/12/2019 |