Healthcare Provider Details

I. General information

NPI: 1376271783
Provider Name (Legal Business Name): RYAN FIORDIMONDO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W CHESTER PIKE
WEST CHESTER PA
19382-4844
US

IV. Provider business mailing address

121 S BROAD ST 15TH FL #191
PHILADELPHIA PA
19107-4533
US

V. Phone/Fax

Practice location:
  • Phone: 610-696-0325
  • Fax:
Mailing address:
  • Phone: 717-524-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW027340
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: