MEDICARE: LAURA M TAYLOR

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	SW138709	PA

General Provider Information

NPI Number	:	1518697457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M TAYLOR

Provider Business Mailing Address
First Line	:	1600 N 18TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3232
Country	:	US
Telephone Number	:	570-991-8316
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N 18TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3232
Country	:	US
Telephone Number	:	570-991-8316
Fax Number	:

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

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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Directions to “ LAURA M TAYLOR ” Practice Location

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