Healthcare Provider Details

I. General information

NPI: 1710450812
Provider Name (Legal Business Name): ABIGAIL ALDERFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 CHESTNUT ST
PHILADELPHIA PA
19104-3014
US

IV. Provider business mailing address

2360 E ALBERT ST
PHILADELPHIA PA
19125-2330
US

V. Phone/Fax

Practice location:
  • Phone: 215-386-1298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCW019957
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCW019957
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: