Provider Demographics
NPI:1952654238
Name:CHARMOY, DANA LYNN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:DANA
Middle Name:LYNN
Last Name:CHARMOY
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 1:4700 WISSAHICKON AVE, BUILDING D, SUITE 118
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4248
Mailing Address - Country:US
Mailing Address - Phone:267-597-3676
Mailing Address - Fax:
Practice Address - Street 1:4700 WISSAHICKON AVE, BUILDING D, SUITE 118
Practice Address - Street 2:
Practice Address - City:PHILADEPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4248
Practice Address - Country:US
Practice Address - Phone:267-597-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0173961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical