MEDICARE: STACEY BARATZ SHAPIRO, LCSW, LLC

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	CW014535	PA

General Provider Information

NPI Number	:	1396778395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACEY BARATZ SHAPIRO, LCSW, LLC

Provider Business Mailing Address
First Line	:	602 E BALTIMORE PIKE
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-1735
Country	:	US
Telephone Number	:	610-608-2960
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 E BALTIMORE PIKE
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-1735
Country	:	US
Telephone Number	:	610-608-2960
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. STACEY BARATZ SHAPIRO
Credential	:	LCSW
Telephone Number	:	610-608-2960

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	10/06/2008

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