Provider Demographics
NPI:1447814140
Name:STAERKER, BRENDA SUE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:STAERKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2545
Mailing Address - Country:US
Mailing Address - Phone:570-904-7363
Mailing Address - Fax:570-348-4079
Practice Address - Street 1:228 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2545
Practice Address - Country:US
Practice Address - Phone:570-904-7363
Practice Address - Fax:570-348-4079
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136002104100000X
PACW0222951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker