Healthcare Provider Details

I. General information

NPI: 1467547968
Provider Name (Legal Business Name): THOMAS JEFFERSON UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 SOUTH 21ST STREET
PHILADELPHIA PA
19146
US

IV. Provider business mailing address

1021 S 21ST ST
PHILADELPHIA PA
19146-2634
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-5979
  • Fax:
Mailing address:
  • Phone: 215-790-9942
  • Fax: 215-790-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number820023
License Number StatePA

VIII. Authorized Official

Name: DR. ROBERT CHARLES STERLING
Title or Position: DIRECTOR
Credential: PHD
Phone: 215-790-9942