Healthcare Provider Details

I. General information

NPI: 1891924338
Provider Name (Legal Business Name): LAURA JAYE GEFTMAN MSS, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 SPRUCE ST
PHILADELPHIA PA
19107-5601
US

IV. Provider business mailing address

1315 SPRUCE ST
PHILADELPHIA PA
19107-5601
US

V. Phone/Fax

Practice location:
  • Phone: 484-469-0554
  • Fax:
Mailing address:
  • Phone: 484-469-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW127299
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: