MEDICARE: LEAH MARINA GILLESPIE L.S.W.

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	SW130725	PA

General Provider Information

NPI Number	:	1417352295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH MARINA GILLESPIE L.S.W.

Provider Business Mailing Address
First Line	:	3716 NANTON PL
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-3029
Country	:	US
Telephone Number	:	610-906-5815
Fax Number	:

Provider Business Practice Location Address
First Line	:	3716 NANTON PL
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-3029
Country	:	US
Telephone Number	:	610-906-5815
Fax Number	:

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

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	10/23/2014

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