MEDICARE: MR. LOGAN HALL LCSW

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		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CW0210066	OTHER	PA	LICENSED CLINICAL SOCIAL WORKER (LCSW)

General Provider Information

NPI Number	:	1861037301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOGAN HALL LCSW

Provider Business Mailing Address
First Line	:	100 S JUNIPER ST # 621
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-2703
Country	:	US
Telephone Number	:	215-458-2036
Fax Number	:	215-798-9581

Provider Business Practice Location Address
First Line	:	100 S JUNIPER ST # 621
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-2703
Country	:	US
Telephone Number	:	215-458-2036
Fax Number	:	215-798-9581

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

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	01/10/2024

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