Healthcare Provider Details

I. General information

NPI: 1710113782
Provider Name (Legal Business Name): PHILADELPHIA MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 PINE ST
PHILADELPHIA PA
19107-5945
US

IV. Provider business mailing address

519 GLENDALE RD
UPPER DARBY PA
19082-5018
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-7068
  • Fax:
Mailing address:
  • Phone: 610-622-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number23522950
License Number StatePA

VIII. Authorized Official

Name: MS. KIA MICHELE HUNTER
Title or Position: BSC/MT
Credential: M.S.
Phone: 215-900-0891