=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528584786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN SEPLOW LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2017
-----------------------------------------------------
Last Update Date | 08/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 CORPORATE DR E
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-8007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-242-8448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 W GOWEN AVE
-----------------------------------------------------
City | PHILA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19119-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-242-8448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW016088
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------