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General NPI Number Information
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NPI Number | 1548992431
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Entity Type | Individual
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Provider Name | SHARIFA DALIA MARTIN LPC
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Gender | Female
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 2491 N 50TH ST BLDG D
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1430
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Country | US
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Telephone | 215-668-3365
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Fax |
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Provider Business Mailing Address
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Address Line | 8540 VERREE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19111-1325
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Country | US
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Telephone | 215-342-7660
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC014503
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License Number State | PA
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