MEDICARE: BENAZIR HOSSAIN LSW

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	104100000X	Social Worker	SW141771	PA

General Provider Information

NPI Number	:	1477375434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENAZIR HOSSAIN LSW

Provider Business Mailing Address
First Line	:	124 W 5TH ST
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-2439
Country	:	US
Telephone Number	:	267-416-9428
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 VIRGINIA DR
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3221
Country	:	US
Telephone Number	:	484-202-0751
Fax Number	:

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

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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