Provider Demographics
NPI:1679000335
Name:HARGROVE, NEA BREYONA (LSW)
Entity Type:Individual
Prefix:MS
First Name:NEA
Middle Name:BREYONA
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 FORD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1605
Mailing Address - Country:US
Mailing Address - Phone:215-301-8721
Mailing Address - Fax:
Practice Address - Street 1:4038 FORD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1605
Practice Address - Country:US
Practice Address - Phone:215-301-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133720104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker