Healthcare Provider Details

I. General information

NPI: 1629393517
Provider Name (Legal Business Name): MICHAEL JOSEPH CIPRESSI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1805
US

IV. Provider business mailing address

644 RECTOR ST
PHILADELPHIA PA
19128-1733
US

V. Phone/Fax

Practice location:
  • Phone: 215-360-7045
  • Fax:
Mailing address:
  • Phone: 215-360-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: