MEDICARE: THRIVE WITHIN PSYCHOLOGICAL SERVICES, 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	103TC0700X	Clinical Psychologist
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1376485615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE WITHIN PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	140 E GLENSIDE AVE # 1027
Second Line	:
City	:	GLENSIDE
State	:	PA
Zip	:	19038-4534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 E GLENSIDE AVE # 1027
Second Line	:
City	:	GLENSIDE
State	:	PA
Zip	:	19038-4534
Country	:	US
Telephone Number	:	267-730-4980
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	KEYONI L ROGERS
Credential	:	PSYD
Telephone Number	:	267-730-4980

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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