Healthcare Provider Details

I. General information

NPI: 1619192572
Provider Name (Legal Business Name): LENORE A WASSERMAN SCOLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ARCH ST 5TH H
PHILA PA
19103-1300
US

IV. Provider business mailing address

109 S EXETER AVE
MARGATE CITY NJ
08402
US

V. Phone/Fax

Practice location:
  • Phone: 215-496-9700
  • Fax: 215-496-0833
Mailing address:
  • Phone: 215-496-9700
  • Fax: 215-496-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012586
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: