Healthcare Provider Details

I. General information

NPI: 1174710800
Provider Name (Legal Business Name): MICHAEL SCHAEFFER LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 CONSHOHOCKEN AVE SUITE 123
PHILA PA
19131
US

IV. Provider business mailing address

545 REVERE ROAD
MERION STATION PA
19066
US

V. Phone/Fax

Practice location:
  • Phone: 215-878-2336
  • Fax: 215-878-2379
Mailing address:
  • Phone: 610-660-0286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW004377E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: