MEDICARE: XAVIER SERGIO HENRIQUEZ

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1922507987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XAVIER SERGIO HENRIQUEZ

Provider Business Mailing Address
First Line	:	1401 S. 31ST STREET 2ND FLOOR
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-3506
Country	:	US
Telephone Number	:	215-925-2400
Fax Number	:	215-925-9162

Provider Business Practice Location Address
First Line	:	4510 FRANKFORD AVENUE 2ND FLOOR
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124
Country	:	US
Telephone Number	:	215-831-9882
Fax Number	:	215-831-9887

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

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	03/08/2026

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Directions to “ XAVIER SERGIO HENRIQUEZ ” Practice Location

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