Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 1041C0700X | Clinical Social Worker | CW018739 | PA |
NPI | 1003246737 |
---|---|
Provider Name | Ashna Nanavati |
First Address | Philadelphia, PA 19146-3506 |
Second Address | Philadelphia, PA 19146-3506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2013 |
Last Update Date | 04/11/2016 |