Provider Demographics
NPI:1356407563
Name:MCINTOSH, VIRGINIA CURRIER (MSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CURRIER
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 W CLIVEDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3601
Mailing Address - Country:US
Mailing Address - Phone:215-844-1995
Mailing Address - Fax:215-843-0440
Practice Address - Street 1:822 MONTGOMERY AVE.
Practice Address - Street 2:STE 314
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:215-844-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000972L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA871482Medicare ID - Type Unspecified