MEDICARE: SAMEER KHETAN 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	SW136509	PA

General Provider Information

NPI Number	:	1649932526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMEER KHETAN LSW

Provider Business Mailing Address
First Line	:	5111 SPRINGFIELD AVE APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4266
Country	:	US
Telephone Number	:	732-648-7181
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 E ALLEN ST # 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-4140
Country	:	US
Telephone Number	:	215-278-9444
Fax Number	:

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

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	10/08/2021

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Directions to “ SAMEER KHETAN LSW” Practice Location

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