Healthcare Provider Details

I. General information

NPI: 1235527177
Provider Name (Legal Business Name): JPA CENTER FOR INTEGRATIVE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SUMMIT AVE
JENKINTOWN PA
19046-3238
US

IV. Provider business mailing address

601 SUMMIT AVE
JENKINTOWN PA
19046-3238
US

V. Phone/Fax

Practice location:
  • Phone: 215-885-1252
  • Fax:
Mailing address:
  • Phone: 215-885-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS016264
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016239
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016689
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5329
License Number StatePA

VIII. Authorized Official

Name: MRS. TERESA ANN MONTANARO
Title or Position: OWNER/DIRECTOR
Credential: M.ED., BCBA
Phone: 215-885-1252