Healthcare Provider Details

I. General information

NPI: 1164749479
Provider Name (Legal Business Name): EMILY HEARN ATR-BC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 11/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 ROOSEVELT BLVD SUITE B
PHILADELPHIA PA
19114-1011
US

IV. Provider business mailing address

1015 EMILY ST
PHILADELPHIA PA
19148-2322
US

V. Phone/Fax

Practice location:
  • Phone: 215-342-4400
  • Fax:
Mailing address:
  • Phone: 267-266-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberPC005468
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: