Healthcare Provider Details

I. General information

NPI: 1598187312
Provider Name (Legal Business Name): ANNA GRACE PANZO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 KENSINGTON AVE
PHILADELPHIA PA
19134-2400
US

IV. Provider business mailing address

3156 KENSINGTON AVE
PHILADELPHIA PA
19134-2400
US

V. Phone/Fax

Practice location:
  • Phone: 215-831-1100
  • Fax:
Mailing address:
  • Phone: 215-831-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017965
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: