MEDICARE: AKIA IMANI IZZARD 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	CW023914	PA

General Provider Information

NPI Number	:	1568248847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKIA IMANI IZZARD LCSW

Provider Business Mailing Address
First Line	:	1234 N 28TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-4536
Country	:	US
Telephone Number	:	215-432-5874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 N 28TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-4536
Country	:	US
Telephone Number	:	215-432-5874
Fax Number	:

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

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	09/04/2023

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Directions to “ AKIA IMANI IZZARD LCSW” Practice Location

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