Provider Demographics
NPI:1518580539
Name:AGRE, ANNE CARLYLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CARLYLE
Last Name:AGRE
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 1:520 N DELAWARE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4228
Mailing Address - Country:US
Mailing Address - Phone:484-519-1459
Mailing Address - Fax:
Practice Address - Street 1:520 N DELAWARE AVE STE 303
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4228
Practice Address - Country:US
Practice Address - Phone:410-591-8253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136767104100000X
PACW0237231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker