Healthcare Provider Details

I. General information

NPI: 1417962283
Provider Name (Legal Business Name): CARIN DEE VENDITTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 W LINCOLN HWY
EXTON PA
19341-2547
US

IV. Provider business mailing address

766 W LINCOLN HWY
EXTON PA
19341-2547
US

V. Phone/Fax

Practice location:
  • Phone: 610-873-2233
  • Fax:
Mailing address:
  • Phone: 610-873-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015996
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier229918-000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMAGELLAN MIS
# 2
Identifier000395600
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer
# 3
Identifier9550244
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 4
Identifier121744
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerJOHN HOPKINS HEALTHCARE
# 5
Identifier2087583
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK
# 6
Identifier3696426000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerIBC-MHS
# 7
IdentifierPHCS 2235157
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerPHCS
# 8
Identifier614442-01
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: