Healthcare Provider Details

I. General information

NPI: 1750398715
Provider Name (Legal Business Name): PSYCHIATRIC PSYCHOLOGICAL & THERAPEUTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 N 3RD ST
HARRISBURG PA
17110-1308
US

IV. Provider business mailing address

3235 N 3RD ST
HARRISBURG PA
17110-1308
US

V. Phone/Fax

Practice location:
  • Phone: 717-234-3838
  • Fax: 717-234-6247
Mailing address:
  • Phone: 717-234-3838
  • Fax: 717-234-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA M. HART
Title or Position: PSYCHOLOGIST/OWNER
Credential: MA, LIC.
Phone: 717-234-3839