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NPI Code Detail

MEDICARE: AMANDA GARLEN

MEDICARE: AMANDA GARLEN
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1215369640
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA GARLEN
Provider Business Mailing Address
First Line : 112 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-1512
Country : US
Telephone Number : 215-568-0860
Fax Number :
Provider Business Practice Location Address
First Line : 2144 CECIL B MOORE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19121-4014
Country : US
Telephone Number : 215-320-6187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2013
Last Update Date : 07/16/2021

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Directions to “ AMANDA GARLEN ” Practice Location

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