Healthcare Provider Details

I. General information

NPI: 1114024577
Provider Name (Legal Business Name): MICHAEL S GELFAND MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVSESITY OF AND WOODLAND AVENUES
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

706 SOUTH 11TH STREET
PHILADELPHIA PA
19147
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax:
Mailing address:
  • Phone: 215-681-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004991
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: