Provider Demographics
NPI:1437787637
Name:WILLIS, NANCY ROBERTS (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ROBERTS
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE GROWTH AND RECOVERY CENTER
Mailing Address - Street 2:452 GERMANTOWN PIKE
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444
Mailing Address - Country:US
Mailing Address - Phone:610-828-4298
Mailing Address - Fax:
Practice Address - Street 1:THE GROWTH AND RECOVERY CENTER
Practice Address - Street 2:452 GERMANTOWN PIKE
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444
Practice Address - Country:US
Practice Address - Phone:610-828-4298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW001138E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker