MEDICARE: EDITH MANNION

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	106H00000X	Marriage & Family Therapist	MF000616	PA

General Provider Information

NPI Number	:	1073921821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH MANNION

Provider Business Mailing Address
First Line	:	422 CONARROE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-3406
Country	:	US
Telephone Number	:	215-509-6109
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 RIDGE AVE
Second Line	:	SUITE 210
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1647
Country	:	US
Telephone Number	:	215-509-6109
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	07/24/2014

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Directions to “ EDITH MANNION ” Practice Location

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