MEDICARE: MIA BEZALEL 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	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538435128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA BEZALEL LCSW

Provider Business Mailing Address
First Line	:	4700 WISSAHICKON AVE STE 118
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-4248
Country	:	US
Telephone Number	:	267-597-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120B WOODLAND AVE 2ND FL
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-3224
Country	:	US
Telephone Number	:	215-727-4721
Fax Number	:	267-350-5932

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

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	09/08/2021

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Directions to “ MIA BEZALEL LCSW” Practice Location

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