Provider Demographics
NPI:1972578805
Name:FRONTINO, MARY CHIRDON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHIRDON
Last Name:FRONTINO
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 1:1310 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6080
Mailing Address - Country:US
Mailing Address - Phone:814-944-9970
Mailing Address - Fax:814-944-9974
Practice Address - Street 1:1310 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6080
Practice Address - Country:US
Practice Address - Phone:814-944-9970
Practice Address - Fax:814-944-9974
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0150161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2103209OtherCIGNA
PA7826281OtherAETNA
PA102390641 0002OtherCBHNP, MEDICAID
PA001325220OtherHIGHMARK PROVIDER ID
PA520337OtherVALUE OPTIONS
PA110678YB7LOtherMEDICARE
PA251214495OtherUNITED BEHAVIORAL HEALTH
PA274889000OtherMEGELLAN