MEDICARE: MR. MALIK RAHSAAN GADSDEN MHS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1710356068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MALIK RAHSAAN GADSDEN MHS

Provider Business Mailing Address
First Line	:	4715 SPRINGFIELD AVE
Second Line	:	UNIT #5
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-3514
Country	:	US
Telephone Number	:	267-987-4098
Fax Number	:

Provider Business Practice Location Address
First Line	:	4715 SPRINGFIELD AVE
Second Line	:	UNIT #5
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-3514
Country	:	US
Telephone Number	:	267-987-4098
Fax Number	:

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

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	09/16/2015

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