=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770095564
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE JOAN CARDONE MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2017
-----------------------------------------------------
Last Update Date | 11/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 N 4TH AVE
-----------------------------------------------------
City | ROYERSFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19468-1952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-948-0393
-----------------------------------------------------
Fax | 610-948-4372
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 COLLEGE AVE
-----------------------------------------------------
City | TRAPPE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19426-2013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-850-6357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW016647
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------