Provider Demographics
NPI:1013286632
Name:DRISCOLL, EARL K (LCSW)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:K
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SHAWMONT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4241
Mailing Address - Country:US
Mailing Address - Phone:215-253-1400
Mailing Address - Fax:215-558-9160
Practice Address - Street 1:1315 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5601
Practice Address - Country:US
Practice Address - Phone:215-253-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0169671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical