Provider Demographics
NPI:1063564318
Name:REDMOND, JEANETTE (LCSW)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:REDMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3626
Mailing Address - Country:US
Mailing Address - Phone:610-566-5886
Mailing Address - Fax:610-566-5886
Practice Address - Street 1:216 S ORANGE ST
Practice Address - Street 2:439 SOUTH AVE.
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3626
Practice Address - Country:US
Practice Address - Phone:610-566-5886
Practice Address - Fax:610-566-5886
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0141371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA230422000Medicaid