Provider Demographics
NPI:1235595943
Name:PANDOLFI, MARIA CONNIE
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CONNIE
Last Name:PANDOLFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CONNIE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1001 CITY AVE UNIT WA804
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3939
Mailing Address - Country:US
Mailing Address - Phone:215-834-3733
Mailing Address - Fax:
Practice Address - Street 1:1001 CITY AVE UNIT WA804
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3939
Practice Address - Country:US
Practice Address - Phone:646-981-7059
Practice Address - Fax:610-206-3785
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW62951041C0700X
PACW0189171041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018344400Medicaid
FLIO401AOtherMEDICARE PTAN GRP
FLIO402ZOtherMEDICARE PTAN