MEDICARE: MR. GREGORY CARL HEDLER 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	CW017971	PA

General Provider Information

NPI Number	:	1700233681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY CARL HEDLER LCSW

Provider Business Mailing Address
First Line	:	63 W LANCASTER AVE
Second Line	:	SUITE 2
City	:	ARDMORE
State	:	PA
Zip	:	19003-1413
Country	:	US
Telephone Number	:	610-314-7996
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 W LANCASTER AVE
Second Line	:	SUITE 2
City	:	ARDMORE
State	:	PA
Zip	:	19003-1413
Country	:	US
Telephone Number	:	610-314-7996
Fax Number	:

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

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	05/19/2016

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