MEDICARE: ABIGAIL ALDERFER

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	CW019957	PA
2	101Y00000X	Counselor	CW019957	PA

General Provider Information

NPI Number	:	1710450812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL ALDERFER

Provider Business Mailing Address
First Line	:	2360 E ALBERT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3014
Country	:	US
Telephone Number	:	215-386-1298
Fax Number	:

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

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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