MEDICARE: MICHAEL ROBERT PARKER 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	CW017930	PA

General Provider Information

NPI Number	:	1467766618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROBERT PARKER LCSW

Provider Business Mailing Address
First Line	:	1611 DENNISTON ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1457
Country	:	US
Telephone Number	:	503-775-1085
Fax Number	:

Provider Business Practice Location Address
First Line	:	5840 ELLSWORTH AVE STE 100
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1727
Country	:	US
Telephone Number	:	412-775-1085
Fax Number	:	412-744-3079

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/31/2024

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