=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225886435
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TYLER JAGGER BOROWIEC M.S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2024
-----------------------------------------------------
Last Update Date | 05/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 WALNUT ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-3523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-344-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 W CENTER AVE
-----------------------------------------------------
City | MAPLE SHADE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08052-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-642-0153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------