Provider Demographics
NPI:1548332430
Name:POWELL, CATHLEEN ANNE (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:ANNE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 SHANE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EFFORT
Mailing Address - State:PA
Mailing Address - Zip Code:18330
Mailing Address - Country:US
Mailing Address - Phone:570-620-1930
Mailing Address - Fax:
Practice Address - Street 1:RT 209
Practice Address - Street 2:HC 1 BOX 110
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322
Practice Address - Country:US
Practice Address - Phone:570-992-4400
Practice Address - Fax:570-992-5262
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0150861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100454Medicare ID - Type Unspecified