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General NPI Number Information
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NPI Number | 1255731436
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Entity Type | Individual
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Provider Name | IAN SILL MSS, LSW
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Gender | Male
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 525 S 4TH ST STE 243
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1573
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Country | US
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Telephone | 215-925-3153
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Fax |
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Provider Business Mailing Address
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Address Line | 919 CARPENTER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-3805
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Country | US
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Telephone | 856-745-8632
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SW132599
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License Number State | PA
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