MEDICARE: PSYCHIATRIC ASSOCIATES

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	261Q00000X	Clinic/Center	MD004053E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225351885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRIC ASSOCIATES

Provider Business Mailing Address
First Line	:	1601 WALNUT STREET
Second Line	:	SUITE 1312
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102
Country	:	US
Telephone Number	:	215-563-8616
Fax Number	:	215-895-5658

Provider Business Practice Location Address
First Line	:	1601 WALNUT STREET
Second Line	:	SUITE 1312
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102
Country	:	US
Telephone Number	:	215-563-8616
Fax Number	:	215-895-5658

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH W. SLAP
Credential	:	M.D.
Telephone Number	:	215-563-8616

Provider Enumeration Date	:	03/10/2010
Last Update Date	:	03/10/2010

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