MEDICARE: LILAH ANNA GOSMAN LPC

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	PC014693	PA

General Provider Information

NPI Number	:	1972130763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILAH ANNA GOSMAN LPC

Provider Business Mailing Address
First Line	:	2118 LOMBARD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1217
Country	:	US
Telephone Number	:	646-342-0157
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST STE 1106
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6212
Country	:	US
Telephone Number	:	646-342-0157
Fax Number	:

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

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	09/30/2022

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