Healthcare Provider Details

I. General information

NPI: 1619686805
Provider Name (Legal Business Name): SAGE HEYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E DAKOTA ST
PHILADELPHIA PA
19125-2053
US

IV. Provider business mailing address

2115 E DAKOTA ST
PHILADELPHIA PA
19125-2053
US

V. Phone/Fax

Practice location:
  • Phone: 917-715-2744
  • Fax:
Mailing address:
  • Phone: 917-715-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023156
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: