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General NPI Number Information
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NPI Number | 1366576084
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Entity Type | Organization
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Legal Business Name | SENIOR OUTREACH SUPPORT SERVICES PC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 29 DECHERT ROAD
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City | CONSHOHCKEN
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State | PA
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Zip | 19428-2114
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Country | US
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Telephone | 610-834-0346
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Fax | 610-834-0346
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Provider Business Mailing Address
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Address Line | 29 DECHERT ROAD
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City | CONSHOHCKEN
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State | PA
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Zip | 19428-2114
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Country | US
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Telephone | 610-834-0346
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Fax | 610-834-0346
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Authorized Official
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Title or Position | PRESIDENT LICENSED CLINICAL SOCIAL
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Name | JOYCE E HANNA
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Credential | MSS LCSW
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Telephone | 610-834-0346
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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 | CW013760
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License Number State | PA
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