MEDICARE: SARAH PULVER PSYCHOTHERAPY, LLC

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	305R00000X	Preferred Provider Organization	SW131112	PA

General Provider Information

NPI Number	:	1255717500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH PULVER PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	4626 LOCUST ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-4519
Country	:	US
Telephone Number	:	267-574-0009
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 E GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3326
Country	:	US
Telephone Number	:	267-574-0009
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	SARAH E PULVER
Credential	:	LSW, MSW
Telephone Number	:	267-574-0009

Provider Enumeration Date	:	08/09/2015
Last Update Date	:	08/09/2015

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