MEDICARE: RAQUEL EMDUR LPC

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	101YP2500X	Professional Counselor
2	103TA0700X	Adult Development & Aging Psychologist	PS020030	PA
3	103TC0700X	Clinical Psychologist	PS020030	PA
4	103TC1900X	Counseling Psychologist	PS020030	PA
5	103TC2200X	Clinical Child & Adolescent Psychologist	PS020030	PA
6	103TF0000X	Family Psychologist	PS020030	PA
7	103TF0200X	Forensic Psychologist	PS020030	PA
8	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PS020030	PA
9	103TP0814X	Psychoanalysis Psychologist	PS020030	PA
10	103TP2701X	Group Psychotherapy Psychologist	PS020030	PA
11	103TR0400X	Rehabilitation Psychologist	PS020030	PA
12	103T00000X	Psychologist	PS020030	PA

General Provider Information

NPI Number	:	1205223138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL EMDUR LPC

Provider Business Mailing Address
First Line	:	PO BOX 34465
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19101-4465
Country	:	US
Telephone Number	:	267-909-6544
Fax Number	:	267-200-0921

Provider Business Practice Location Address
First Line	:	63 W LANCASTER AVE STE 8
Second Line	:
City	:	ARDMORE
State	:	PA
Zip	:	19003-1413
Country	:	US
Telephone Number	:	215-948-4227
Fax Number	:	267-200-0921

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

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	01/04/2024

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