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General NPI Number Information
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NPI Number | 1649932526
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Entity Type | Individual
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Provider Name | SAMEER KHETAN LSW
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Gender | Male
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 112 E ALLEN ST # 3
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City | PHILADELPHIA
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State | PA
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Zip | 19125-4140
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Country | US
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Telephone | 215-278-9444
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Fax |
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Provider Business Mailing Address
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Address Line | 5111 SPRINGFIELD AVE APT 1
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City | PHILADELPHIA
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State | PA
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Zip | 19143-4266
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Country | US
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Telephone | 732-648-7181
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW136509
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License Number State | PA
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