Healthcare Provider Details

I. General information

NPI: 1295175602
Provider Name (Legal Business Name): GRACE UNSAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2013
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELMONT BEHAVIORAL HOSPITAL, LLC 4200 MONUMENT ROAD
PHILADELPHIA PA
19131
US

IV. Provider business mailing address

BELMONT BEHAVIORAL HOSPITAL, LLC 4200 MONUMENT ROAD
PHILADELPHIA PA
19131-1625
US

V. Phone/Fax

Practice location:
  • Phone: 215-877-2000
  • Fax: 215-581-3993
Mailing address:
  • Phone: 215-877-2000
  • Fax: 215-581-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberOS018756
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: