MEDICARE: MS. INEZ QUICK-EVANS 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	101YM0800X	Mental Health Counselor	SW010315L	PA

General Provider Information

NPI Number	:	1770844011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. INEZ QUICK-EVANS LSW

Provider Business Mailing Address
First Line	:	2603 CECIL B MOORE AVE
Second Line	:	MEN&WOMEN FOR HUMAN EXCELLENCE
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-2826
Country	:	US
Telephone Number	:	215-769-7045
Fax Number	:	215-769-7046

Provider Business Practice Location Address
First Line	:	2603 CECIL B MOORE AVE
Second Line	:	MEN&WOMEN FOR HUMAN EXCELLENCE
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-2826
Country	:	US
Telephone Number	:	215-769-7045
Fax Number	:	215-769-7046

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

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	06/04/2012

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