Healthcare Provider Details

I. General information

NPI: 1730303272
Provider Name (Legal Business Name): JEWISH FAMILY AND CHILDREN'S SERVICE OF GREATER PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 VERREE RD
PHILADELPHIA PA
19116-3611
US

IV. Provider business mailing address

309 E MAPLE AVE
MERCHANTVILLE NJ
08109-2621
US

V. Phone/Fax

Practice location:
  • Phone: 215-673-0100
  • Fax:
Mailing address:
  • Phone: 856-317-0706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1041C0700
License Number StatePA

VIII. Authorized Official

Name: SUSAN WILAND
Title or Position: CFO
Credential:
Phone: 215-496-9700