Healthcare Provider Details

I. General information

NPI: 1679606974
Provider Name (Legal Business Name): JEWISH FAMILY PSYCH SERV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ARCH ST 5TH FL
PHILADELPHIA PA
19103-1300
US

IV. Provider business mailing address

2100 ARCH ST 5TH FL
PHILADELPHIA PA
19103-1300
US

V. Phone/Fax

Practice location:
  • Phone: 215-496-9700
  • Fax: 215-496-6622
Mailing address:
  • Phone: 215-496-9700
  • Fax: 215-496-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StatePA

VIII. Authorized Official

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