Healthcare Provider Details

I. General information

NPI: 1194555169
Provider Name (Legal Business Name): EMILY WEXLER MT-BC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 E SLOCUM ST
PHILADELPHIA PA
19119-2149
US

IV. Provider business mailing address

267 E SLOCUM ST
PHILADELPHIA PA
19119-2149
US

V. Phone/Fax

Practice location:
  • Phone: 917-843-0038
  • Fax:
Mailing address:
  • Phone: 917-843-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020822
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number18297
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: