Healthcare Provider Details

I. General information

NPI: 1912994245
Provider Name (Legal Business Name): RICHARD BOND MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 WALNUT ST
IRWIN PA
15642-3533
US

IV. Provider business mailing address

629 WALNUT ST
IRWIN PA
15642-3533
US

V. Phone/Fax

Practice location:
  • Phone: 412-969-7464
  • Fax:
Mailing address:
  • Phone: 412-969-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW008936L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: