Healthcare Provider Details

I. General information

NPI: 1972196277
Provider Name (Legal Business Name): SLADE MAGENTA ROFF LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 OLD YORK RD STE 224
ELKINS PARK PA
19027-1426
US

IV. Provider business mailing address

200 LOCUST ST APT 25H
PHILADELPHIA PA
19106-0118
US

V. Phone/Fax

Practice location:
  • Phone: 267-626-2018
  • Fax:
Mailing address:
  • Phone: 218-213-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW136451
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023076
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: