Healthcare Provider Details

I. General information

NPI: 1770184541
Provider Name (Legal Business Name): ADRIAN KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CITY AVE STE 15
BALA CYNWYD PA
19004-1724
US

IV. Provider business mailing address

1440 N 28TH ST
PHILADELPHIA PA
19121-3617
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-0005
  • Fax:
Mailing address:
  • Phone: 267-772-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH007326
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: