MEDICARE: OLIVIA FRANCES SIROTNAK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC017489	PA

General Provider Information

NPI Number	:	1033941653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA FRANCES SIROTNAK LPC

Provider Business Mailing Address
First Line	:	1307 GERMANTOWN AVE UNIT 18A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-4649
Country	:	US
Telephone Number	:	570-335-3547
Fax Number	:

Provider Business Practice Location Address
First Line	:	1819 JFK BLVD STE 302
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1729
Country	:	US
Telephone Number	:	610-265-3400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/21/2024

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