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General NPI Number Information
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NPI Number | 1407350309
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Entity Type | Individual
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Provider Name | DWANE QUINCY BUDHEAH LSW
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 160 E ERIE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-1011
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Country | US
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Telephone | 267-600-2031
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Fax |
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Provider Business Mailing Address
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Address Line | 4226 W THOMPSON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-1026
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Country | US
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Telephone | 215-667-7133
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 134752
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License Number State | PA
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