Healthcare Provider Details

I. General information

NPI: 1821400334
Provider Name (Legal Business Name): NIKOO RAOOFIAN ELGAMIL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKOO RAOOFIAN LCSW-C

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 12/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10541 DRUMMOND RD
PHILADELPHIA PA
19154-3807
US

IV. Provider business mailing address

10541 DRUMMOND RD
PHILADELPHIA PA
19154-3807
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-7625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018054
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15743
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: