MEDICARE: DREXEL UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	251S00000X	Community/Behavioral Health Agency
3	261Q00000X	Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1598271207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREXEL UNIVERSITY

Provider Business Mailing Address
First Line	:	1601 CHERRY ST STE 11511
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1310
Country	:	US
Telephone Number	:	215-255-7822
Fax Number	:	215-255-7825

Provider Business Practice Location Address
First Line	:	1505 RACE ST FL 6
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1119
Country	:	US
Telephone Number	:	215-762-3431
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	ASHLEY H KUKLA
Credential	:
Telephone Number	:	215-255-7782

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	12/18/2017

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Directions to “DREXEL UNIVERSITY ” Practice Location

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