Healthcare Provider Details

I. General information

NPI: 1306125471
Provider Name (Legal Business Name): MISS LORI ANN HINSDALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 SPRINGDALE DR
EXTON PA
19341-2841
US

IV. Provider business mailing address

41 EVELYN LN
QUAKERTOWN PA
18951-3815
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-1488
  • Fax:
Mailing address:
  • Phone: 336-932-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017038
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1144329111
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: