MEDICARE: NORA JESSY AHERN LCSW

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	104100000X	Social Worker	131343	NY
2	1041C0700X	Clinical Social Worker	092797	NY
3	1041C0700X	Clinical Social Worker	CW022757	PA

General Provider Information

NPI Number	:	1215416565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORA JESSY AHERN LCSW

Provider Business Mailing Address
First Line	:	130 MONUMENT RD APT 421
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1762
Country	:	US
Telephone Number	:	917-660-5833
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 MAIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2142
Country	:	US
Telephone Number	:	917-660-5833
Fax Number	:

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

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/15/2022

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