Healthcare Provider Details

I. General information

NPI: 1528512449
Provider Name (Legal Business Name): JENNIFER LEE TOADVINE PHD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 S RANDOLPH ST #5
PHILADELPHIA PA
19147-4052
US

IV. Provider business mailing address

1012 S RANDOLPH ST #5
PHILADELPHIA PA
19147-4052
US

V. Phone/Fax

Practice location:
  • Phone: 215-208-5213
  • Fax:
Mailing address:
  • Phone: 215-208-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000695
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: