MEDICARE: STEFANIE WAKEMAN MSW, LSW

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	104100000X	Social Worker	SW122600	PA

General Provider Information

NPI Number	:	1710484779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE WAKEMAN MSW, LSW

Provider Business Mailing Address
First Line	:	2525 MEREDITH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2421
Country	:	US
Telephone Number	:	267-973-5453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 RACE ST FL 6
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1119
Country	:	US
Telephone Number	:	215-762-1170
Fax Number	:

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

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	04/06/2018

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