MEDICARE: NOMI TEUTSCH

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	CW019942	PA

General Provider Information

NPI Number	:	1174014351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOMI TEUTSCH

Provider Business Mailing Address
First Line	:	4720 CEDAR AVE APT 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2048
Country	:	US
Telephone Number	:	215-720-5832
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-3224
Country	:	US
Telephone Number	:	215-727-4721
Fax Number	:

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

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/23/2018

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Directions to “ NOMI TEUTSCH ” Practice Location

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