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NPI Code Detail

MEDICARE: JANE F ILGENFRITZ LCSW

MEDICARE: JANE F ILGENFRITZ 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
1101YM0800XMental Health CounselorCW013523PA

General Provider Information

NPI Number : 1275182081
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE F ILGENFRITZ LCSW
Provider Business Mailing Address
First Line : 364 GRANITE ST
Second Line :
City : CORNWALL BORO
State : PA
Zip : 17042-9248
Country : US
Telephone Number : 717-540-7278
Fax Number :
Provider Business Practice Location Address
First Line : 746 CUMBERLAND ST
Second Line :
City : LEBANON
State : PA
Zip : 17042-5236
Country : US
Telephone Number : 717-540-7278
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2019
Last Update Date : 09/05/2019

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