MEDICARE: NEXT STEP ADDICTION AND COUNSELING SERVICES

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	CW017073	PA

General Provider Information

NPI Number	:	1922479963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXT STEP ADDICTION AND COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	3415 W CHESTER PIKE
Second Line	:	SUITE 102
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-4279
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 W CHESTER PIKE
Second Line	:	SUITE 102
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-4279
Country	:	US
Telephone Number	:	610-304-3070
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	TERRY MAZDA
Credential	:	MSS LCSW
Telephone Number	:	610-304-3070

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	10/16/2015

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