Individual
DALE P MYRTETUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1045 KASMIR AVE, SUITE 101, BENSALEM, PA 19020-4520
(215) 244-2624
Mailing address
1045 KASMIR AVE, SUITE 101, BENSALEM, PA 19020-4520
(215) 244-2624
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW012317
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11529542
CAQH
PA
01
—
2124455000
INDEPENCE BLUE CROSS
PA
01
—
438269
KEYSTONE EAST
PA
01
—
464611
VALUE OPTIONS MIS#
PA
Enumeration date
11/17/2006
Last updated
07/08/2007
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