Healthcare Provider Details

I. General information

NPI: 1326813155
Provider Name (Legal Business Name): TINA CARUGNO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3432 BARCLAY ST
PHILADELPHIA PA
19129-1428
US

IV. Provider business mailing address

3432 BARCLAY ST
PHILADELPHIA PA
19129-1428
US

V. Phone/Fax

Practice location:
  • Phone: 215-964-2873
  • Fax:
Mailing address:
  • Phone: 215-964-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number7421261
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018423
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: