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General NPI Number Information
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NPI Number | 1700647286
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Entity Type | Individual
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Provider Name | LUC TEYSSIER LSW
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Gender | Male
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 255 S 17TH ST STE 2200
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6221
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Country | US
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Telephone | 267-519-0241
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Fax |
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Provider Business Mailing Address
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Address Line | 150 S INDEPENDENCE MALL W APT 902
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3424
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Country | US
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Telephone | 703-344-4280
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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 | SW140434
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License Number State | PA
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