Provider Demographics
NPI:1417962283
Name:VENDITTA, CARIN DEE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARIN
Middle Name:DEE
Last Name:VENDITTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2547
Mailing Address - Country:US
Mailing Address - Phone:610-873-2233
Mailing Address - Fax:
Practice Address - Street 1:766 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2547
Practice Address - Country:US
Practice Address - Phone:610-873-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0159961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA229918-000OtherMAGELLAN MIS
MD000395600Medicaid
PA9550244OtherAETNA
MD121744OtherJOHN HOPKINS HEALTHCARE
PA2087583OtherHIGHMARK
PA3696426000OtherIBC-MHS
MDPHCS 2235157OtherPHCS
MD614442-01OtherBCBS
MD121744OtherJOHN HOPKINS HEALTHCARE