Healthcare Provider Details

I. General information

NPI: 1114815289
Provider Name (Legal Business Name): JODY ZHONG DR. (PH.D.)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 AMBRIDGE PL
PHILADELPHIA PA
19114-1101
US

IV. Provider business mailing address

10230 AMBRIDGE PL
PHILADELPHIA PA
19114-1121
US

V. Phone/Fax

Practice location:
  • Phone: 267-808-0548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPA020472
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: