Healthcare Provider Details

I. General information

NPI: 1720308885
Provider Name (Legal Business Name): PROMOTING YOUTH EMPOWERMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 W GIRARD AVE
PHILADELPHIA PA
19130-1313
US

IV. Provider business mailing address

220 FLAMINGO RD
MARLTON NJ
08053-5106
US

V. Phone/Fax

Practice location:
  • Phone: 267-265-1767
  • Fax:
Mailing address:
  • Phone: 215-356-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THERESA A PRESCOTT
Title or Position: CHIEF MEDICAL OFFICER
Credential: DO
Phone: 215-356-2043