MEDICARE: MELANIE DREWENCKI 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	104100000X	Social Worker	SW130736	PA
2	1041C0700X	Clinical Social Worker	CW019068	PA

General Provider Information

NPI Number	:	1083022610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE DREWENCKI LCSW

Provider Business Mailing Address
First Line	:	4001 MAIN ST STE 102
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2142
Country	:	US
Telephone Number	:	717-385-4790
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 MAIN ST STE 102
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2142
Country	:	US
Telephone Number	:	717-385-4790
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	09/12/2019

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