MEDICARE: MELISSA KRECHMER LSW

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	1041C0700X	Clinical Social Worker	SW130921	PA

General Provider Information

NPI Number	:	1396104238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KRECHMER LSW

Provider Business Mailing Address
First Line	:	1015 ANNIN ST FL 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-4641
Country	:	US
Telephone Number	:	717-659-0528
Fax Number	:

Provider Business Practice Location Address
First Line	:	1429 WALNUT ST
Second Line	:	SUITE 1300
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3218
Country	:	US
Telephone Number	:	215-563-7863
Fax Number	:

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

Provider Enumeration Date	:	02/21/2016
Last Update Date	:	02/21/2016

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