MEDICARE: ALEEMA S. HAYNESWORTH

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	101YP2500X	Professional Counselor	PC010341	PA

General Provider Information

NPI Number	:	1710598677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEEMA S. HAYNESWORTH

Provider Business Mailing Address
First Line	:	5500 KINGSESSING AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-5329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 KINGSESSING AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-5329
Country	:	US
Telephone Number	:	484-841-9224
Fax Number	:

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

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	01/24/2023

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