MEDICARE: MICHAEL ERWIN 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	SW128914	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW128914	OTHER	PA	SOCIAL WORKER LICENSE

General Provider Information

NPI Number	:	1841563483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ERWIN LSW

Provider Business Mailing Address
First Line	:	4408 LOCUST ST
Second Line	:	APT. 1R
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2987
Country	:	US
Telephone Number	:	215-390-1500
Fax Number	:	215-382-1099

Provider Business Practice Location Address
First Line	:	4040 MARKET ST
Second Line	:	SUITE 320
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3003
Country	:	US
Telephone Number	:	215-390-1500
Fax Number	:	215-382-1099

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

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	02/13/2012

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