MEDICARE: JENNIFER KING LSW

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	CW024844	PA
2	104100000X	Social Worker	SW137555	PA

General Provider Information

NPI Number	:	1588263008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KING LSW

Provider Business Mailing Address
First Line	:	718 S 55TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2506
Country	:	US
Telephone Number	:	617-792-1783
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S 2ND ST STE 301
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1612
Country	:	US
Telephone Number	:	157-328-2442
Fax Number	:

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

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	05/05/2026

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