Patricia Ann Dershem, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW008439L Issued in PA

Practice address

302 West Central Avenue
Avis, PA 17721-1070

Phone

(570) 753-3620

Fax

(570) 753-3620

NPI assigned

Sep 5, 2006

Sex

Female

Sole proprietor

Yes

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.

• Avis Behavioral Health

  • Clinical Social Worker
  • Avis, PA
  • NPI 1932112174
  NPD (past) Authorized official CLINICAL

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154424448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 WEST CENTRAL AVENUE",
            "city": "AVIS",
            "state": "PA",
            "postal_code": "177211070",
            "telephone_number": "570-753-3620",
            "fax_number": "570-753-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 WEST CENTRAL AVENUE",
            "city": "AVIS",
            "state": "PA",
            "postal_code": "177211070",
            "telephone_number": "570-753-3620",
            "fax_number": "570-753-3620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSHEM",
        "first_name": "PATRICIA",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW008439L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "062223S68",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2117726",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "474483",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS HIGHMARK",
            "identifier": "1617662",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH",
            "identifier": "817938",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Avis Behavioral Health
• Stacy Clarke, MA, LPC, NCC
• Kelly Eichenlaub, LPC
• Enso Counseling & Wellness, LLC
• Heather Lynn Fowler, LPC
• Freeman Counseling Services
• Hannah Marie Freeman, LCSW

• All providers in Avis, PA
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.