Active NPI
Audrey Irene Boltz, MSW, LSW
- Social Worker
- Lebanon, PA
National Provider Identifier
1033366695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- SW011017L
- Practice address
- 3030 Chestnut St
Lebanon, PA 17042-2518 - Phone
- (717) 273-8000
- Fax
- (717) 273-8244
- NPI assigned
- Aug 26, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | SW011017L | PA | Primary |
Addresses
Primary practice location
3030 Chestnut St
Lebanon, PA 17042-2518
Mailing address
3030 Chestnut St
Lebanon, PA 17042-2518
Phone (717) 273-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW011017L | PA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Treatment Systems, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Methadone Clinic
- Lebanon, PA
- NPI 1700996790
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219708800000",
"number": "1033366695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3030 CHESTNUT ST",
"city": "LEBANON",
"state": "PA",
"postal_code": "170422518",
"telephone_number": "717-273-8000",
"fax_number": "717-273-8244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3030 CHESTNUT ST",
"city": "LEBANON",
"state": "PA",
"postal_code": "170422518",
"telephone_number": "717-273-8000",
"fax_number": "717-273-8244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLTZ",
"first_name": "AUDREY",
"middle_name": "IRENE",
"name_prefix": "Mrs.",
"credential": "MSW, LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-26",
"last_updated": "2008-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "PA",
"license": "SW011017L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.