MEDICARE: MS. MARTHA MARY DURKIN MSW

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	SW000733E	PA

General Provider Information

NPI Number	:	1558313304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA MARY DURKIN MSW

Provider Business Mailing Address
First Line	:	5335 KNOX ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-6211
Country	:	US
Telephone Number	:	215-843-6176
Fax Number	:	215-247-5175

Provider Business Practice Location Address
First Line	:	7600 STENTON AVE
Second Line	:	SUITE 1-F
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3231
Country	:	US
Telephone Number	:	215-247-5400
Fax Number	:	215-247-5175

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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