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General NPI Number Information
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NPI Number | 1033945100
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Entity Type | Organization
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Legal Business Name | ISKRA THERAPY LLC
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 1518 WALNUT ST STE 607
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3404
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Country | US
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Telephone | 215-253-8361
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Fax |
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Provider Business Mailing Address
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Address Line | 925 DICKINSON ST UNIT 18011
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City | PHILADELPHIA
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State | PA
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Zip | 19147-6357
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Country | US
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Telephone | 215-233-8361
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JACK HARMELIN
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Credential | LCSW
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Telephone | 609-289-0739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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