Individual
JANE BACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMCSW
Contact information
Practice address
850 W LANCASTER AVE, 2ND FLOORD, BRYN MAWR, PA 19010-3220
(610) 520-1510
(610) 520-1517
Mailing address
106 KINGFIELD RD, PHILADELPHIA, PA 19115-4011
(347) 377-1855
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW019049
PA
Other
Enumeration date
09/23/2016
Last updated
09/23/2016
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