Provider Demographics
NPI:1366576084
Name:SENIOR OUTREACH SUPPORT SERVICES PC
Entity type:Organization
Organization Name:SENIOR OUTREACH SUPPORT SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT LICENSED CLINICAL SOCIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MSS LCSW
Authorized Official - Phone:610-834-0346
Mailing Address - Street 1:29 DECHERT ROAD
Mailing Address - Street 2:
Mailing Address - City:CONSHOHCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2114
Mailing Address - Country:US
Mailing Address - Phone:610-834-0346
Mailing Address - Fax:610-834-0346
Practice Address - Street 1:29 DECHERT ROAD
Practice Address - Street 2:
Practice Address - City:CONSHOHCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2114
Practice Address - Country:US
Practice Address - Phone:610-834-0346
Practice Address - Fax:610-834-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092875Medicare ID - Type Unspecified