MEDICARE: PHILADELPHIA CENTER FOR PSYCHOTHERAPY

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	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1578220232	OTHER	PA	NPI TYPE 1

General Provider Information

NPI Number	:	1396497640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA CENTER FOR PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	255 S 17TH ST STE 1900
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	267-209-3209
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST STE 1900
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	267-209-3209
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST, OWNER
Name	:	DR. HIDER SHAABAN
Credential	:	PSYD
Telephone Number	:	267-277-3179

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	05/18/2026

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Directions to “PHILADELPHIA CENTER FOR PSYCHOTHERAPY ” Practice Location

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