MEDICARE: DR. JANE ELLEN TAUSIG PH.D., L.C.S.W.

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	CW014998	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2233829000	OTHER		PERSONAL CHOICE
2	027629	OTHER		VALUE OPTIONS PIN
3	4271463	OTHER	PA	AETNA PROVIDER #

General Provider Information

NPI Number	:	1609884485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE ELLEN TAUSIG PH.D., L.C.S.W.

Provider Business Mailing Address
First Line	:	512 FOX RD
Second Line	:
City	:	GLENSIDE
State	:	PA
Zip	:	19038-2808
Country	:	US
Telephone Number	:	215-901-3185
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 YORKTOWN PLZ
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1427
Country	:	US
Telephone Number	:	215-901-3185
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	01/11/2008

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