| Pivots Potential | |
|
33 W Franklin St Ste 2 Hagerstown MD 21740-4826 | |
| (240) 457-9505 | |
| Not Available |
| Full Name | Pivots Potential |
|---|---|
| Speciality | Social Worker |
| Location | 33 W Franklin St Ste 2, Hagerstown, Maryland |
| Authorized Official Name and Position | Vida Lynne Penn-leon (EXECUTIVE OFFICER) |
| Authorized Official Contact | 4108683498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pivots Potential 1401 Haven Rd Apt B12 Hagerstown MD 21742-3097 Ph: (410) 868-3498 | Pivots Potential 33 W Franklin St Ste 2 Hagerstown MD 21740-4826 Ph: (240) 457-9505 |
| NPI Number | 1659097525 |
|---|---|
| Provider Enumeration Date | 10/12/2022 |
| Last Update Date | 05/07/2024 |
| Certification Date | 02/05/2024 |
| Medicare PECOS PAC ID | 5799152724 |
|---|---|
| Medicare Enrollment ID | O20221104000649 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659097525 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Vida Lynne Penn-leon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225150980 PECOS PAC ID: 6608243639 Enrollment ID: I20221104000873 |
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