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General NPI Number Information
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NPI Number | 1497222491
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Entity Type | Individual
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Provider Name | JACOB ANDREW MAUERSBERG MT-BC
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Gender | Male
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Dates
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Enumeration Date | 10/28/2018
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Last Update Date | 10/26/2024
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Provider Practice Location Address
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Address Line | 1433 POPLAR ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1669
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Country | US
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Telephone | 301-848-3962
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Fax |
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Provider Business Mailing Address
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Address Line | 1433 POPLAR ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1669
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Country | US
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Telephone | 301-848-3962
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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 | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 14675
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License Number State | PA
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