Healthcare Provider Details

I. General information

NPI: 1104806371
Provider Name (Legal Business Name): PATRICIA ANN DANZIK MSS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PINE TREE RD
RADNOR PA
19087-3709
US

IV. Provider business mailing address

201 PINE TREE RD
RADNOR PA
19087-3709
US

V. Phone/Fax

Practice location:
  • Phone: 610-964-8028
  • Fax: 610-964-0779
Mailing address:
  • Phone: 610-964-8028
  • Fax: 610-964-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW000713L
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierDA640355
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUS SHIELD
# 2
Identifier4541448
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA BEHAVIORAL HLTH.
# 3
Identifier118470
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMHN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: