Healthcare Provider Details

I. General information

NPI: 1497001341
Provider Name (Legal Business Name): HALLIE KUSHNER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WALNUT ST SUITE 706
PHILADELPHIA PA
19102-2944
US

IV. Provider business mailing address

1101 MARKET ST FL 30
PHILADELPHIA PA
19107-2934
US

V. Phone/Fax

Practice location:
  • Phone: 215-839-9735
  • Fax:
Mailing address:
  • Phone: 215-503-3685
  • Fax: 215-955-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS017226
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: