Provider Demographics
NPI:1215416565
Name:AHERN, NORA JESSY (LCSW)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:JESSY
Last Name:AHERN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MONUMENT RD APT 421
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1762
Mailing Address - Country:US
Mailing Address - Phone:917-660-5833
Mailing Address - Fax:
Practice Address - Street 1:4001 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-2142
Practice Address - Country:US
Practice Address - Phone:917-660-5833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131343104100000X
NY0927971041C0700X
PACW0227571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker