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General NPI Number Information
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NPI Number | 1568828135
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Entity Type | Organization
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Legal Business Name | EMPOWERMENT AND RECOVERY PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 1420 WALNUT ST STE 1412
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4014
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Country | US
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Telephone | 215-694-2383
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 WALNUT ST STE 1412
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4014
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Country | US
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Telephone | 215-694-2383
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | DR. CYNTHIA CLOSS
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Credential | DSW, LCSW
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Telephone | 215-694-2383
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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 | CW015019
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License Number State | PA
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