MEDICARE: MRS. PATRICIA ANN DANZIK MSS

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
1	1041C0700X	Clinical Social Worker	CW000713L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA640355	OTHER	PA	HIGHMARK BLUS SHIELD
2	4541448	OTHER	PA	AETNA BEHAVIORAL HLTH.
3	118470	OTHER	PA	MHN

General Provider Information

NPI Number	:	1104806371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ANN DANZIK MSS

Provider Business Mailing Address
First Line	:	201 PINE TREE RD
Second Line	:
City	:	RADNOR
State	:	PA
Zip	:	19087-3709
Country	:	US
Telephone Number	:	610-964-8028
Fax Number	:	610-964-0779

Provider Business Practice Location Address
First Line	:	201 PINE TREE RD
Second Line	:
City	:	RADNOR
State	:	PA
Zip	:	19087-3709
Country	:	US
Telephone Number	:	610-964-8028
Fax Number	:	610-964-0779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2006
Last Update Date	:	07/08/2007

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