Active NPI
Tracy Ann Difonzo, LCSW
- Clinical Social Worker
- Wyndmoor, PA
National Provider Identifier
1790300937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 015602
- Practice address
- 504 Spring LN
Wyndmoor, PA 19038-8413 - Phone
- (610) 420-4263
- NPI assigned
- Jun 13, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 015602 | PA | Primary |
Addresses
Primary practice location
504 Spring LN
Wyndmoor, PA 19038-8413
Mailing address
504 Spring LN
Wyndmoor, PA 19038-8413
Phone (610) 420-4263
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 29, 2024 through Aug 29, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015602 | PA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592006400000",
"number": "1790300937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 SPRING LN",
"city": "WYNDMOOR",
"state": "PA",
"postal_code": "190388413",
"telephone_number": "610-420-4263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 SPRING LN",
"city": "WYNDMOOR",
"state": "PA",
"postal_code": "190388413",
"telephone_number": "610-420-4263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIFONZO",
"first_name": "TRACY",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-13",
"last_updated": "2020-06-13",
"certification_date": "2020-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PA",
"license": "015602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyndmoor, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.