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General NPI Number Information
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NPI Number | 1457095291
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Entity Type | Individual
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Provider Name | JARED KORELITZ GOLANT
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Gender | Male
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 05/13/2022
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Provider Practice Location Address
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Address Line | 255 S 17TH ST STE 1307
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6213
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Country | US
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Telephone | 215-282-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 SPRUCE ST APT 20B
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4544
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Country | US
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Telephone |
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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 | SW136591
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW136591
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License Number State | PA
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