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NPI Code Detail

MEDICARE: MR. FREDERICK WILLIAM PENCE LSW

MEDICARE: MR. FREDERICK WILLIAM PENCE 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
1104100000XSocial WorkerSW130934PA
21041C0700XClinical Social Worker34011893AIN

General Provider Information

NPI Number : 1619728722
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FREDERICK WILLIAM PENCE LSW
Provider Business Mailing Address
First Line : 4911 PARKSIDE AVE N
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19131-2609
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2100 N MAIN ST # 304
Second Line :
City : CROWN POINT
State : IN
Zip : 46307-1877
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2024
Last Update Date : 01/20/2026

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Directions to “ MR. FREDERICK WILLIAM PENCE LSW” Practice Location

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