MEDICARE: MR. PATRICK MICHAEL CONDO MSW

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	101YM0800X	Mental Health Counselor	CW000227L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	633827	OTHER	PA	HIGHMARK
2	110268	OTHER	PA	VALUEOPTIONS
3	4603776	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1497819205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK MICHAEL CONDO MSW

Provider Business Mailing Address
First Line	:	8981 NORWIN AVE
Second Line	:	SUITE 101
City	:	IRWIN
State	:	PA
Zip	:	15642-2746
Country	:	US
Telephone Number	:	724-864-3031
Fax Number	:	724-864-3032

Provider Business Practice Location Address
First Line	:	8981 NORWIN AVE
Second Line	:	SUITE 101
City	:	IRWIN
State	:	PA
Zip	:	15642-2746
Country	:	US
Telephone Number	:	724-864-3031
Fax Number	:	724-864-3032

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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