Healthcare Provider Details

I. General information

NPI: 1356540694
Provider Name (Legal Business Name): TRANSITIONAL PHASE III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PRESEDENTIAL BLVD
PHILA PA
19131
US

IV. Provider business mailing address

PO BOX 811
BALA CYNWYD PA
19004
US

V. Phone/Fax

Practice location:
  • Phone: 215-877-7465
  • Fax: 215-877-7465
Mailing address:
  • Phone: 215-877-7465
  • Fax: 215-883-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JO BENAIT
Title or Position: CEO
Credential: PSYCHOLOGIST
Phone: 215-877-7465