MEDICARE: JENNIFER J SERRATORE 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	CW016432	PA

General Provider Information

NPI Number	:	1114258647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER J SERRATORE L.C.S.W.

Provider Business Mailing Address
First Line	:	1827 HARTEL AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3530
Country	:	US
Telephone Number	:	267-970-1804
Fax Number	:	215-437-7054

Provider Business Practice Location Address
First Line	:	1601 WALNUT ST STE 608
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2904
Country	:	US
Telephone Number	:	267-970-1804
Fax Number	:	215-437-7054

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

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	01/22/2010

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