Healthcare Provider Details

I. General information

NPI: 1245121011
Provider Name (Legal Business Name): AIMEE CANTWELL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 VIRGINIA DR
FORT WASHINGTON PA
19034-3221
US

IV. Provider business mailing address

237 NORTHWESTERN AVE
PHILADELPHIA PA
19128-1808
US

V. Phone/Fax

Practice location:
  • Phone: 484-202-0751
  • Fax:
Mailing address:
  • Phone: 215-272-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW141986
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: