MEDICARE: AMY WALLWORK LMFT

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	106H00000X	Marriage & Family Therapist	MF000568	PA

General Provider Information

NPI Number	:	1164666574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY WALLWORK LMFT

Provider Business Mailing Address
First Line	:	727 WELSH RD
Second Line	:	202
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-6310
Country	:	US
Telephone Number	:	215-914-2119
Fax Number	:	215-914-1663

Provider Business Practice Location Address
First Line	:	727 WELSH RD
Second Line	:	202
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-6310
Country	:	US
Telephone Number	:	215-914-2119
Fax Number	:	215-914-1663

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

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	04/29/2009

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