Healthcare Provider Details

I. General information

NPI: 1033272000
Provider Name (Legal Business Name): LORE KUTSOP ANDRESCAVAGE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 LEOPARD RD
PAOLI PA
19301-1518
US

IV. Provider business mailing address

1 WINDING WAY
MALVERN PA
19355-1718
US

V. Phone/Fax

Practice location:
  • Phone: 508-233-2193
  • Fax:
Mailing address:
  • Phone: 215-896-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115048
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025110
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: