MEDICARE: GRACE P KINKLER 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	1041C0700X	Clinical Social Worker	CW024451	PA

General Provider Information

NPI Number	:	1790551620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE P KINKLER LSW

Provider Business Mailing Address
First Line	:	465 W HARVEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3818
Country	:	US
Telephone Number	:	609-472-5218
Fax Number	:

Provider Business Practice Location Address
First Line	:	465 W HARVEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3818
Country	:	US
Telephone Number	:	609-472-5218
Fax Number	:

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

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	01/23/2026

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