MEDICARE: PALANTE PSYCHOTHERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1053055996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALANTE PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	817 N 5TH ST UNIT 202
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-2136
Country	:	US
Telephone Number	:	610-428-1027
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 N RANDOLPH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-4163
Country	:	US
Telephone Number	:	610-428-1027
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA M JONES
Credential	:	LCSW
Telephone Number	:	610-428-1027

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	04/26/2022

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