MEDICARE: JENNA GRABIAK 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	CW018650	PA

General Provider Information

NPI Number	:	1700342383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA GRABIAK LCSW

Provider Business Mailing Address
First Line	:	142 W MARKET ST STE 2
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-2930
Country	:	US
Telephone Number	:	610-616-5890
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 W MARKET ST
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-2930
Country	:	US
Telephone Number	:	215-806-0795
Fax Number	:

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

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	02/20/2019

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