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General NPI Number Information
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NPI Number | 1811300122
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Entity Type | Individual
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Provider Name | PHOENIX WOOD LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 525 S 4TH ST STE 598
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City | PHILADELPHIA
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State | PA
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Zip | 19147
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Country | US
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Telephone | 267-603-4463
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Fax |
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Provider Business Mailing Address
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Address Line | 525 S 4TH ST STE 598
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1581
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Country | US
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Telephone |
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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 | 131460
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW019534
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License Number State | PA
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