MEDICARE: MR. KEVIN CARIDAD LSW

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	104100000X	Social Worker	SW126251	PA
2	1041C0700X	Clinical Social Worker	CW017308	PA

General Provider Information

NPI Number	:	1518158377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN CARIDAD LSW

Provider Business Mailing Address
First Line	:	125 EMERYVILLE DR STE 230
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5020
Country	:	US
Telephone Number	:	724-609-5002
Fax Number	:	724-299-8964

Provider Business Practice Location Address
First Line	:	125 EMERYVILLE DR STE 230
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5020
Country	:	US
Telephone Number	:	724-609-5002
Fax Number	:	724-299-8964

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

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	11/27/2017

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Directions to “ MR. KEVIN CARIDAD LSW” Practice Location

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