Healthcare Provider Details

I. General information

NPI: 1649557794
Provider Name (Legal Business Name): MEGAN REDDISH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 BETHLEHEM PIKE #2A
FLOURTOWN PA
19031-1501
US

IV. Provider business mailing address

18 RONALD CIR
ORELAND PA
19075-1320
US

V. Phone/Fax

Practice location:
  • Phone: 215-836-7040
  • Fax: 215-836-7058
Mailing address:
  • Phone: 215-517-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012427
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: