MEDICARE: MS. AMANDA BORSON LCSW

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

General Provider Information

NPI Number	:	1619469822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA BORSON LCSW

Provider Business Mailing Address
First Line	:	255 S 17TH ST STE 1509
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST STE 1509
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6215
Country	:	US
Telephone Number	:	267-417-7634
Fax Number	:

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

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	10/23/2023

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