Healthcare Provider Details

I. General information

NPI: 1255153854
Provider Name (Legal Business Name): DAYA MIRABAI DEUSKAR MSS, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 ARCH ST STE 304
PHILADELPHIA PA
19103-1350
US

IV. Provider business mailing address

2133 ARCH ST STE 304
PHILADELPHIA PA
19103-1350
US

V. Phone/Fax

Practice location:
  • Phone: 445-447-3297
  • Fax: 445-999-5294
Mailing address:
  • Phone: 445-447-3297
  • Fax: 445-999-5294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW142075
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: