MEDICARE: MRS. KAITLYN ELIZABETH FERM 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	104100000X	Social Worker	SW140242	PA

General Provider Information

NPI Number	:	1427733195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAITLYN ELIZABETH FERM LSW

Provider Business Mailing Address
First Line	:	68 WABASH ST STE 100
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15220-5435
Country	:	US
Telephone Number	:	412-455-6890
Fax Number	:	412-455-6891

Provider Business Practice Location Address
First Line	:	1407 MOUNT ROYAL BLVD
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2205
Country	:	US
Telephone Number	:	412-455-6890
Fax Number	:	412-455-6891

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

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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