MEDICARE: MA'AT THERAPEUTIC SERVICES

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	101YP2500X	Professional Counselor	PC004165	PA

General Provider Information

NPI Number	:	1275980187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MA'AT THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	6228 GREENE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-2618
Country	:	US
Telephone Number	:	215-275-4117
Fax Number	:	267-385-6008

Provider Business Practice Location Address
First Line	:	6228 GREENE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-2618
Country	:	US
Telephone Number	:	215-275-4117
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NZINGHA MA'AT
Credential	:	MS, LPC
Telephone Number	:	215-275-4117

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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Directions to “MA'AT THERAPEUTIC SERVICES ” Practice Location

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