MEDICARE: MS. MERLE DRAKE 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	CW013008	PA

General Provider Information

NPI Number	:	1477859882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MERLE DRAKE LCSW

Provider Business Mailing Address
First Line	:	4100 MAIN ST
Second Line	:	STE 403
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-1623
Country	:	US
Telephone Number	:	215-487-3000
Fax Number	:	215-487-3111

Provider Business Practice Location Address
First Line	:	4100 MAIN ST
Second Line	:	STE 403
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-1623
Country	:	US
Telephone Number	:	215-487-3000
Fax Number	:	215-487-3111

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

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	01/03/2017

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