MEDICARE: SARAH MICHELLE WAXMAN LCSW

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	1041C0700X	Clinical Social Worker	CW020374	PA

General Provider Information

NPI Number	:	1326649963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MICHELLE WAXMAN LCSW

Provider Business Mailing Address
First Line	:	2550 GRAYS FERRY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2331
Country	:	US
Telephone Number	:	856-296-6237
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 GRAYS FERRY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2331
Country	:	US
Telephone Number	:	856-296-6237
Fax Number	:

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

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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