=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679165161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARAE PARIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2021
-----------------------------------------------------
Last Update Date | 02/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 E JOHNSON ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19138-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-839-6212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7715 CRITTENDEN ST # 220
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19118-4473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-839-6212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW126820
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------