MEDICARE: MS. MICHAEL-LYNN HALE MSW, 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	CW002226L	PA

General Provider Information

NPI Number	:	1790093938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHAEL-LYNN HALE MSW, LCSW

Provider Business Mailing Address
First Line	:	4700 WISSAHICKON AVE
Second Line	:	BUILDING D - SUITE 118
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-4248
Country	:	US
Telephone Number	:	215-843-2580
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 B WOODLAND AVENUE
Second Line	:	SECOND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-3224
Country	:	US
Telephone Number	:	267-350-5940
Fax Number	:

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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