MEDICARE: KAREN KEVRESHE

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	CWO15024	PA

General Provider Information

NPI Number	:	1013124189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN KEVRESHE

Provider Business Mailing Address
First Line	:	238 S CAMAC ST
Second Line	:	3B
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-7019
Country	:	US
Telephone Number	:	267-234-1833
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 N 8TH ST
Second Line	:	402
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3916
Country	:	US
Telephone Number	:	215-496-0707
Fax Number	:	215-627-9042

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL AFFAIRS
Name	:	DR. ANDREA ETTINGOFF
Credential	:
Telephone Number	:	215-496-0707

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/10/2007

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