Healthcare Provider Details

I. General information

NPI: 1215520044
Provider Name (Legal Business Name): CARLOS ECHEVARRIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S 31ST ST
PHILADELPHIA PA
19146-3506
US

IV. Provider business mailing address

1400 S 31ST ST
PHILADELPHIA PA
19146-3402
US

V. Phone/Fax

Practice location:
  • Phone: 215-755-7700
  • Fax:
Mailing address:
  • Phone: 215-755-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number226601
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025480
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW027372
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: