Provider Demographics
NPI:1134520521
Name:TAYLOR, NATIA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NATIA
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NATIA
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4700 WISSAHICKON AVENUE
Mailing Address - Street 2:BLDG D, SUITE 118
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4248
Mailing Address - Country:US
Mailing Address - Phone:267-597-3800
Mailing Address - Fax:267-597-3622
Practice Address - Street 1:6120B WOODLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142
Practice Address - Country:US
Practice Address - Phone:267-350-5198
Practice Address - Fax:267-597-3622
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0182481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical