Healthcare Provider Details

I. General information

NPI: 1003175670
Provider Name (Legal Business Name): PHILADELPHIA SCHOOL OF PSYCHOANALYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S 16TH ST
PHILADELPHIA PA
19102-4907
US

IV. Provider business mailing address

316 S 16TH ST
PHILADELPHIA PA
19102-4907
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-8244
  • Fax: 215-732-8454
Mailing address:
  • Phone: 215-732-8244
  • Fax: 215-732-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPC0004614
License Number StatePA

VIII. Authorized Official

Name: MRS. LISA CORREALE
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW, NCPSYA
Phone: 215-732-8244