Healthcare Provider Details

I. General information

NPI: 1922725522
Provider Name (Legal Business Name): MIRIAM FIFE ED.D, MSS, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 16TH ST
PHILADELPHIA PA
19102-4908
US

IV. Provider business mailing address

110 SAINT PAULS RD
ARDMORE PA
19003-2811
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-8244
  • Fax:
Mailing address:
  • Phone: 215-917-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW137987
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: