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NPI Code Detail

MEDICARE: SUSAN M. MCILVAIN MSW, LISW-S

MEDICARE: SUSAN M. MCILVAIN MSW, LISW-S
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
11041C0700XClinical Social WorkerCW022054PA

General Provider Information

NPI Number : 1427209212
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN M. MCILVAIN MSW, LISW-S
Provider Business Mailing Address
First Line : 3535 MARKET ST FL 2
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-3317
Country : US
Telephone Number : 215-746-6701
Fax Number : 215-756-7350
Provider Business Practice Location Address
First Line : 3535 MARKET ST FL 2
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-3317
Country : US
Telephone Number : 215-746-6701
Fax Number : 215-756-7350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2008
Last Update Date : 07/08/2022

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