MEDICARE: MS. ANNE EIZABETH STANFIELD-HAGERT 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	104100000X	Social Worker	LSW122592	PA

General Provider Information

NPI Number	:	1972628964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE EIZABETH STANFIELD-HAGERT LCSW

Provider Business Mailing Address
First Line	:	1836 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2303
Country	:	US
Telephone Number	:	215-704-9285
Fax Number	:	215-462-5823

Provider Business Practice Location Address
First Line	:	1836 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2303
Country	:	US
Telephone Number	:	215-704-9285
Fax Number	:	215-462-5823

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	03/14/2008

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