Jodi Gerson Miscannon, LSW

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

SW010517L Issued in PA

Practice address

102 E Mermaid LN
Philadelphia, PA 19118-3507

Phone

(215) 248-7605

NPI assigned

Jun 4, 2009

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1244073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244073600000",
    "number": "1972739902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 E MERMAID LN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191183507",
            "telephone_number": "215-248-7605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E MERMAID LN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191183507",
            "telephone_number": "215-248-7605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISCANNON",
        "first_name": "JODI",
        "middle_name": "GERSON",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-04",
        "last_updated": "2009-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "PA",
            "license": "SW010517L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sobia K Mirza, M.D.
• Tariq Mirza, DMD
• Zaki Mirza
• Mina Mirzaee
• Khulkar Mirzozoda, MD, MBA
• Anne E Miscia
• Richard Bruce Misher, DDS
• Aaron David Mishkin, M.D.
• Rosalind Marcia Mishkin, OTR
• Priya Mishra, MBBS

• Early Intervention Provider Agency in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Early Intervention Provider Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.