MEDICARE: ALEX TELEWODA THERAPIST

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1295033710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX TELEWODA THERAPIST

Provider Business Mailing Address
First Line	:	200 FEDERAL ST
Second Line	:	SUITE 227
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1061
Country	:	US
Telephone Number	:	855-447-1351
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 FEDERAL ST
Second Line	:	SUITE 227
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1061
Country	:	US
Telephone Number	:	855-447-1351
Fax Number	:

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

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	03/08/2011

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