Provider Demographics
NPI:1871521815
Name:ZELEWICZ, JENNIFER RAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RAE
Last Name:ZELEWICZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:RAE
Other - Last Name:RIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:EAGLES MERE
Mailing Address - State:PA
Mailing Address - Zip Code:17731-0033
Mailing Address - Country:US
Mailing Address - Phone:570-419-5435
Mailing Address - Fax:833-222-3713
Practice Address - Street 1:1012 WASHINGTON BLVD REAR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701
Practice Address - Country:US
Practice Address - Phone:570-419-5435
Practice Address - Fax:833-222-3713
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03269001OtherCAPITAL BLUE CROSS