Healthcare Provider Details

I. General information

NPI: 1427884006
Provider Name (Legal Business Name): MS. MAYA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 BETHLEHEM PIKE STE 340
ERDENHEIM PA
19038-8118
US

IV. Provider business mailing address

781 N JUDSON ST
PHILADELPHIA PA
19130-2507
US

V. Phone/Fax

Practice location:
  • Phone: 215-282-3004
  • Fax: 215-282-8597
Mailing address:
  • Phone: 215-282-3004
  • Fax: 215-282-8597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW139910
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: