MEDICARE: LMW THERAPY SERVICES, LLC

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	106H00000X	Marriage & Family Therapist	MF000668	PA

General Provider Information

NPI Number	:	1447505656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LMW THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	1500 MARKET ST
Second Line	:	PO BOX 58145
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2100
Country	:	US
Telephone Number	:	317-710-0354
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 PENN CENTER PLZ
Second Line	:	1500 JOHN F KENNEDY BLVD, SUITE 200
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1721
Country	:	US
Telephone Number	:	317-710-0354
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA M WILKINSON
Credential	:	LMFT
Telephone Number	:	317-710-0354

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	07/13/2012

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