Healthcare Provider Details

I. General information

NPI: 1710809215
Provider Name (Legal Business Name): VINCENT DANTE RECUPIDO LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E ALLEN ST UNIT 3
PHILADELPHIA PA
19125-4189
US

IV. Provider business mailing address

257 SEVENTH AVE
MEDIA PA
19063-5915
US

V. Phone/Fax

Practice location:
  • Phone: 215-278-9444
  • Fax:
Mailing address:
  • Phone: 484-478-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW144460
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: