MEDICARE: MR. MICHAEL HANOWITZ L.C.S.W.

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	CW013065	PA

General Provider Information

NPI Number	:	1114209848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL HANOWITZ L.C.S.W.

Provider Business Mailing Address
First Line	:	1415 N BROAD ST
Second Line	:	SUTIE 221C
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3323
Country	:	US
Telephone Number	:	215-588-5629
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 N BROAD ST
Second Line	:	SUITE 221C
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3323
Country	:	US
Telephone Number	:	215-588-5629
Fax Number	:

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	02/12/2014

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