Provider Demographics
NPI:1013583236
Name:PYANKOV, MARITA
Entity Type:Individual
Prefix:
First Name:MARITA
Middle Name:
Last Name:PYANKOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E LANCASTER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2145
Mailing Address - Country:US
Mailing Address - Phone:484-679-6299
Mailing Address - Fax:
Practice Address - Street 1:308 E LANCASTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2145
Practice Address - Country:US
Practice Address - Phone:484-679-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker