MEDICARE: CAITLIN MCELVENNY LCSW

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	CW021796	PA

General Provider Information

NPI Number	:	1457929374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN MCELVENNY LCSW

Provider Business Mailing Address
First Line	:	1233 LOCUST ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5400
Country	:	US
Telephone Number	:	215-985-4448
Fax Number	:	215-732-1478

Provider Business Practice Location Address
First Line	:	1211 CHESTNUT ST STE 605
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4117
Country	:	US
Telephone Number	:	215-525-8657
Fax Number	:	215-988-9062

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

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	06/16/2021

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