MEDICARE: MS. NEA BREYONA HARGROVE 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	SW133720	PA

General Provider Information

NPI Number	:	1679000335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NEA BREYONA HARGROVE LSW

Provider Business Mailing Address
First Line	:	4038 FORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1605
Country	:	US
Telephone Number	:	215-301-8721
Fax Number	:

Provider Business Practice Location Address
First Line	:	4038 FORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1605
Country	:	US
Telephone Number	:	215-301-8721
Fax Number	:

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

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	05/12/2017

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