MEDICARE: SARAH DEGEORGE LSW

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	SW128749	PA

General Provider Information

NPI Number	:	1023418217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH DEGEORGE LSW

Provider Business Mailing Address
First Line	:	7800C STENTON AVE
Second Line	:	APT 306
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800C STENTON AVE
Second Line	:	APT 306
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3029
Country	:	US
Telephone Number	:	724-679-0886
Fax Number	:

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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