Provider Demographics
NPI:1982214664
Name:THACKER, ANN (LSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:THACKER
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 1:4500 WORTH ST # C303
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3491
Mailing Address - Country:US
Mailing Address - Phone:609-462-4396
Mailing Address - Fax:
Practice Address - Street 1:4500 WORTH ST # C303
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3491
Practice Address - Country:US
Practice Address - Phone:609-462-4396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137264104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker