MEDICARE: MR. WILLAIM COFFEY 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 014371	PA

General Provider Information

NPI Number	:	1104917681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLAIM COFFEY LCSW

Provider Business Mailing Address
First Line	:	201 S 18TH ST APT 1716
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5934
Country	:	US
Telephone Number	:	609-706-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 MARKET ST
Second Line	:	SUITE 700
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4134
Country	:	US
Telephone Number	:	215-575-9140
Fax Number	:

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	05/24/2024

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