MEDICARE: EMPOWERMENT AND RECOVERY PSYCHOTHERAPY, LLC

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	CW015019	PA

General Provider Information

NPI Number	:	1568828135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERMENT AND RECOVERY PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	1420 WALNUT ST STE 1412
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4014
Country	:	US
Telephone Number	:	215-694-2383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 WALNUT ST STE 1412
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4014
Country	:	US
Telephone Number	:	215-694-2383
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	DR. CYNTHIA CLOSS
Credential	:	DSW, LCSW
Telephone Number	:	215-694-2383

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	05/11/2022

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