Provider Demographics
NPI:1013158708
Name:PRENTICE, NATHANIEL SARTELL (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:SARTELL
Last Name:PRENTICE
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 ROSE GLEN RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1824
Mailing Address - Country:US
Mailing Address - Phone:610-659-2744
Mailing Address - Fax:
Practice Address - Street 1:1630 ROSE GLEN RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-1824
Practice Address - Country:US
Practice Address - Phone:610-659-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0154071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical