Provider Demographics
NPI:1184486813
Name:DAIGLE, AUDREY (LSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:DAIGLE
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 1:2316 BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2907
Mailing Address - Country:US
Mailing Address - Phone:508-579-7162
Mailing Address - Fax:
Practice Address - Street 1:954 MONTGOMERY AVE STE 2
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1938
Practice Address - Country:US
Practice Address - Phone:412-242-8443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133572104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker