MEDICARE: MS. KRISTEN ERIN ANTOLINE LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SW124104	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	581008	OTHER	PA	VALUE BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1639391592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN ERIN ANTOLINE LSW

Provider Business Mailing Address
First Line	:	2066 MERCER ROAD
Second Line	:
City	:	NEW BRIGHTON
State	:	PA
Zip	:	15066-3337
Country	:	US
Telephone Number	:	724-846-7782
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 OHIO RIVER BLVD.
Second Line	:
City	:	BADEN
State	:	PA
Zip	:	15005-1914
Country	:	US
Telephone Number	:	724-869-2222
Fax Number	:	724-869-3155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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