Healthcare Provider Details

I. General information

NPI: 1073917191
Provider Name (Legal Business Name): NOAH DZUBA MSW, ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S WASHINGTON SQ APT 1616
PHILADELPHIA PA
19106-4125
US

IV. Provider business mailing address

604 S WASHINGTON SQ APT 1616
PHILADELPHIA PA
19106-4125
US

V. Phone/Fax

Practice location:
  • Phone: 267-536-5565
  • Fax:
Mailing address:
  • Phone: 267-536-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW63323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: