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NPI Code Detail

MEDICARE: MS. JEANETTE ANNE PAILAS M.A./A.T.R.-L.P.C.

MEDICARE: MS. JEANETTE ANNE PAILAS M.A./A.T.R.-L.P.C.
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
1101YP2500XProfessional CounselorPC004973PA

General Provider Information

NPI Number : 1598090136
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEANETTE ANNE PAILAS M.A./A.T.R.-L.P.C.
Provider Business Mailing Address
First Line : 6706 LINCOLN DR
Second Line :
City : PHILA
State : PA
Zip : 19119-3155
Country : US
Telephone Number : 215-300-6170
Fax Number :
Provider Business Practice Location Address
First Line : 4641 ROOSEVELT BLVD
Second Line :
City : PHILA
State : PA
Zip : 19124-2343
Country : US
Telephone Number : 215-831-2634
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2009
Last Update Date : 10/15/2009

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