Healthcare Provider Details

I. General information

NPI: 1700395894
Provider Name (Legal Business Name): POSITIVE MIND AND BODY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BALA AVE. 3RD FLOOR SUITE
BALA CYNWYD PA
19004
US

IV. Provider business mailing address

110 BALA AVE. 3RD FLOOR SUITE
BALA CYNWYD PA
19004
US

V. Phone/Fax

Practice location:
  • Phone: 484-406-5047
  • Fax: 610-664-1726
Mailing address:
  • Phone: 484-406-5047
  • Fax: 610-664-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC009417
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009417
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018049
License Number StatePA

VIII. Authorized Official

Name: DR. LYDIA KAY SIT
Title or Position: COFOUNDER, PSYCHIATRIST
Credential: M.D.
Phone: 856-553-7748