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NPI Code Detail

MEDICARE: MR. JEFFREY BAKELY LCSW

MEDICARE: MR. JEFFREY BAKELY 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
11041C0700XClinical Social WorkerCW012808PA

General Provider Information

NPI Number : 1225153992
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY BAKELY LCSW
Provider Business Mailing Address
First Line : 222 W DURAND ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-2505
Country : US
Telephone Number : 215-843-1093
Fax Number :
Provider Business Practice Location Address
First Line : 2055 E ALLEGHENY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-3832
Country : US
Telephone Number : 215-427-5800
Fax Number : 215-427-5767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 01/19/2011

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