Healthcare Provider Details

I. General information

NPI: 1235738824
Provider Name (Legal Business Name): COMMUNITY INTEGRATED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N 5TH ST STE 101
PHILADELPHIA PA
19123-4009
US

IV. Provider business mailing address

441 N 5TH ST STE 101
PHILADELPHIA PA
19123-4009
US

V. Phone/Fax

Practice location:
  • Phone: 215-870-7667
  • Fax: 215-238-7423
Mailing address:
  • Phone: 215-870-7667
  • Fax: 215-238-7423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN SCHONFELD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 215-870-7667