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NPI Code Detail

MEDICARE: CRISTHIAN DANTAGNAN M.ED., LPC

MEDICARE: CRISTHIAN DANTAGNAN M.ED., LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorPC006813PA
2101YP2500XProfessional CounselorPC006813PA

General Provider Information

NPI Number : 1033598578
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRISTHIAN DANTAGNAN M.ED., LPC
Provider Business Mailing Address
First Line : 1055 E BALTIMORE PIKE STE 300
Second Line :
City : MEDIA
State : PA
Zip : 19063-5173
Country : US
Telephone Number : 610-892-3800
Fax Number :
Provider Business Practice Location Address
First Line : 255 S 17TH ST STE 1010
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6210
Country : US
Telephone Number : 610-892-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2015
Last Update Date : 03/27/2024

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