Provider Demographics
NPI:1497819205
Name:CONDO, PATRICK MICHAEL (MSW)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:CONDO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8981 NORWIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2746
Mailing Address - Country:US
Mailing Address - Phone:724-864-3031
Mailing Address - Fax:724-864-3032
Practice Address - Street 1:8981 NORWIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-2746
Practice Address - Country:US
Practice Address - Phone:724-864-3031
Practice Address - Fax:724-864-3032
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000227L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA633827OtherHIGHMARK
PA110268OtherVALUEOPTIONS
PA4603776OtherAETNA
PAR07643Medicare UPIN
PA633827Medicare ID - Type Unspecified