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General NPI Number Information
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NPI Number | 1518580539
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Entity Type | Individual
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Provider Name | ANNE CARLYLE AGRE LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 520 N DELAWARE AVE STE 303
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4228
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Country | US
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Telephone | 410-591-8253
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Fax |
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Provider Business Mailing Address
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Address Line | 520 N DELAWARE AVE STE 303
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4228
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Country | US
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Telephone | 484-519-1459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW136767
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW023723
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License Number State | PA
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