Colleen Reckless, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW021521 Issued in PA

Practice address

1300 Old Plank Rd
Mayfield, PA 18433-1973

Phone

(570) 281-6222

NPI assigned

Nov 25, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Colleen Brydon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1689210684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 CHRISTY LN",
            "city": "SCOTT TOWNSHIP",
            "state": "PA",
            "postal_code": "184477723",
            "telephone_number": "570-575-2312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 OLD PLANK RD",
            "city": "MAYFIELD",
            "state": "PA",
            "postal_code": "184331973",
            "telephone_number": "570-281-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RECKLESS",
        "first_name": "COLLEEN",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-25",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW021521",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "127222",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "BRYDON",
            "credential": "LSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.