Eileen B Addis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW018387 Issued in PA

Practice address

4100 Main St Ste 403
Philadelphia, PA 19127-1623

Phone

(215) 487-3000

NPI assigned

Jan 18, 2018

Reactivated

Jul 5, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Supportive Older Women'S Network

  • Social Worker
  • Philadelphia, PA
  • NPI 1245533660
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1336657709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MALLARD RD",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190872344",
            "telephone_number": "610-247-8504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 MAIN ST STE 403",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191271623",
            "telephone_number": "215-487-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDIS",
        "first_name": "EILEEN",
        "middle_name": "B",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-18",
        "last_updated": "2024-07-05",
        "certification_date": "2021-06-28",
        "deactivation_date": "2021-06-28",
        "reactivation_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW018387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Srikala Addepalli, M.D.
• Marlene Adderly
• Addiction Consultants of Pennsylvania LLC
• Addiction Medicine and Health Advocates, Incorporated
• Francesca Addiego, CRNA
• Victoria Marie Addis, M.D.
• Aisha Ayanna Addison
• Kevin Addison, ATC
• David Jerry Addley, D.O.
• Joan Mureen Addley, DO

• All providers in Philadelphia, PA
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.