MEDICARE: JENNIFER LYNNE BARE 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	CW024033	PA

General Provider Information

NPI Number	:	1801624572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNNE BARE LCSW

Provider Business Mailing Address
First Line	:	2301 CHERRY ST APT 6A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1061
Country	:	US
Telephone Number	:	215-776-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 CHERRY ST APT 6A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1061
Country	:	US
Telephone Number	:	215-776-0148
Fax Number	:

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

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	07/24/2024

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