=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053623249
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN AXELROD SABAG LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2010
-----------------------------------------------------
Last Update Date | 08/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8431 GERMANTOWN AVE 2ND FLOOR
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19118-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-272-8056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 ARCH STREET 5TH FLOOR
-----------------------------------------------------
City | PHILA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19103-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-256-2115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW016294
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------