MEDICARE: MRS. KATRINA FRYDLEWICZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW-015174	PA

General Provider Information

NPI Number	:	1013097807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATRINA FRYDLEWICZ LCSW

Provider Business Mailing Address
First Line	:	400 BROAD STREET
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446
Country	:	US
Telephone Number	:	215-368-2022
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N BROAD ST
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-2414
Country	:	US
Telephone Number	:	215-368-2022
Fax Number	:	215-855-6454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	06/11/2012

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