Provider Demographics
NPI:1619192572
Name:WASSERMAN SCOLA, LENORE A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LENORE
Middle Name:A
Last Name:WASSERMAN SCOLA
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 1:109 S EXETER AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402
Mailing Address - Country:US
Mailing Address - Phone:215-496-9700
Mailing Address - Fax:215-496-0833
Practice Address - Street 1:2100 ARCH ST
Practice Address - Street 2:5TH H
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19103-1300
Practice Address - Country:US
Practice Address - Phone:215-496-9700
Practice Address - Fax:215-496-0833
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0125861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000008810009Medicaid
PA663348Medicare ID - Type Unspecified