Provider Demographics
NPI:1710248091
Name:ACHTERT, DOUGLAS C (MSS, LSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:C
Last Name:ACHTERT
Suffix:
Gender:M
Credentials:MSS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 CECIL B MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-2826
Mailing Address - Country:US
Mailing Address - Phone:215-769-7045
Mailing Address - Fax:215-769-7046
Practice Address - Street 1:1055 E BALTIMORE PIKE STE 303
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5173
Practice Address - Country:US
Practice Address - Phone:610-892-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128747104100000X
PACW017941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker