Healthcare Provider Details

I. General information

NPI: 1306207667
Provider Name (Legal Business Name): DO WHAT YOU'RE BUILT FOR FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 BURBRIDGE ST
PHILADELPHIA PA
19144-2505
US

IV. Provider business mailing address

6327 BURBRIDGE ST
PHILADELPHIA PA
19144-2505
US

V. Phone/Fax

Practice location:
  • Phone: 215-991-9066
  • Fax: 215-991-9062
Mailing address:
  • Phone: 215-991-9066
  • Fax: 215-991-9062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS016044
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW130970
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSW130970
License Number StatePA

VIII. Authorized Official

Name: DR. DANIEL LEE
Title or Position: CEO
Credential: PSYD
Phone: 215-991-9066