Basic Information
| Provider Information | |||||||||
| NPI: | 1831175579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | GEORG-ETTA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDERSON | ||||||||
| OtherFirstName: | GEORGI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 450 GIBNER RD | ||||||||
| Address2: | DUNHAM U.S. ARMY HEALTH CLINIC | ||||||||
| City: | CARLISLE BARRACKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170135003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172453041 | ||||||||
| FaxNumber: | 7172453815 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 GIBNER RD | ||||||||
| Address2: | DUNHAM U.S. ARMY HEALTH CLINIC | ||||||||
| City: | CARLISLE BARRACKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170135003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172453041 | ||||||||
| FaxNumber: | 7172453815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW008102L | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.