MEDICARE: MARY EPPS CADC

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	101YM0800X	Mental Health Counselor	555666111	PA
2	251S00000X	Community/Behavioral Health Agency	555666111	PA

General Provider Information

NPI Number	:	1285055335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY EPPS CADC

Provider Business Mailing Address
First Line	:	2514 N BROAD ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19132-4013
Country	:	US
Telephone Number	:	215-599-8914
Fax Number	:	215-226-1278

Provider Business Practice Location Address
First Line	:	2514 N BROAD ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19132-4013
Country	:	US
Telephone Number	:	215-599-8914
Fax Number	:	215-226-1278

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

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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Directions to “ MARY EPPS CADC” Practice Location

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