Provider Demographics
NPI:1477570232
Name:TRIPODI, PETER F JR (LCSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:F
Last Name:TRIPODI
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509
Mailing Address - Country:US
Mailing Address - Phone:570-961-0896
Mailing Address - Fax:
Practice Address - Street 1:1141 CLAY AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18509
Practice Address - Country:US
Practice Address - Phone:570-347-7773
Practice Address - Fax:570-558-0777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001108L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07161792Medicaid
638144Medicare ID - Type Unspecified