MEDICARE: KEVIN REID

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	SW133395	PA

General Provider Information

NPI Number	:	1740733914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN REID

Provider Business Mailing Address
First Line	:	1208 S 7TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-4840
Country	:	US
Telephone Number	:	267-279-5134
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 S 7TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-4840
Country	:	US
Telephone Number	:	267-279-5134
Fax Number	:

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

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	07/25/2016

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Directions to “ KEVIN REID ” Practice Location

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