MEDICARE: DANIELLE PETTIGREW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1942774757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE PETTIGREW

Provider Business Mailing Address
First Line	:	3641 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3641 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104
Country	:	US
Telephone Number	:	215-823-5800
Fax Number	:

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

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	11/15/2024

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