MEDICARE: MRS. PERSIDA IOANA GHIBILIC MA, LPC

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	101YM0800X	Mental Health Counselor	PC004401	PA
2	101YP2500X	Professional Counselor	PC004401	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11744553	OTHER		CAQH

General Provider Information

NPI Number	:	1518146844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PERSIDA IOANA GHIBILIC MA, LPC

Provider Business Mailing Address
First Line	:	1067 HILLVIEW TURN
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-2816
Country	:	US
Telephone Number	:	215-947-7570
Fax Number	:	215-947-7570

Provider Business Practice Location Address
First Line	:	1730 WELSH RD
Second Line	:	SUITE 2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-4213
Country	:	US
Telephone Number	:	215-552-8101
Fax Number	:

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

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/02/2007

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