MEDICARE: MS. MARIS H. MENIN 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	SW012486L	PA

General Provider Information

NPI Number	:	1083652994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIS H. MENIN LSW

Provider Business Mailing Address
First Line	:	3125 RIDGE PIKE
Second Line	:
City	:	EAGLEVILLE
State	:	PA
Zip	:	19403-1407
Country	:	US
Telephone Number	:	610-630-2111
Fax Number	:	610-630-4003

Provider Business Practice Location Address
First Line	:	3125 RIDGE PIKE
Second Line	:
City	:	EAGLEVILLE
State	:	PA
Zip	:	19403-1407
Country	:	US
Telephone Number	:	610-630-2111
Fax Number	:	610-630-4003

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	09/12/2011

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