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General NPI Number Information
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NPI Number | 1154707602
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Entity Type | Individual
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Provider Name | BRIAN HAINS LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 1315 WALNUT ST SUITE1619
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4719
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Country | US
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Telephone | 267-320-7015
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Fax |
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Provider Business Mailing Address
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Address Line | 5820 OVERBROOK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1221
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Country | US
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Telephone | 267-320-7015
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW-006998-L
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License Number State | PA
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