MEDICARE: MRS. NZINGHA MA'AT MS, LPC

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	101YP2500X	Professional Counselor	PC004165	PA

General Provider Information

NPI Number	:	1861883373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NZINGHA MA'AT MS, LPC

Provider Business Mailing Address
First Line	:	6228 GREENE ST UNIT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-2618
Country	:	US
Telephone Number	:	215-275-4117
Fax Number	:

Provider Business Practice Location Address
First Line	:	6228 GREENE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-2618
Country	:	US
Telephone Number	:	215-275-4117
Fax Number	:

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

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	05/01/2016

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