Healthcare Provider Details

I. General information

NPI: 1548879836
Provider Name (Legal Business Name): ADAM JOSEPH RZEPKA LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 11/27/2023
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 N BROAD ST
PHILADELPHIA PA
19132-4013
US

IV. Provider business mailing address

902 TREE ST
PHILADELPHIA PA
19148-3122
US

V. Phone/Fax

Practice location:
  • Phone: 215-599-2845
  • Fax:
Mailing address:
  • Phone: 215-779-2992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW137181
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: