MEDICARE: MICHELLE OWEN

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	126583-01	NY

General Provider Information

NPI Number	:	1902778814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE OWEN

Provider Business Mailing Address
First Line	:	228 PARK AVE S # 16968
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-1502
Country	:	US
Telephone Number	:	646-760-8421
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 RITTENHOUSE SQ APT 301
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5621
Country	:	US
Telephone Number	:	646-760-8421
Fax Number	:

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

Provider Enumeration Date	:	09/19/2025
Last Update Date	:	01/20/2026

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