Healthcare Provider Details

I. General information

NPI: 1023177144
Provider Name (Legal Business Name): JOSEPH J. PETERS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH BROAD STREET 17TH FLOOR
PHILADELPHIA PA
19110
US

IV. Provider business mailing address

100 SOUTH BROAD STREET 17TH FLOOR
PHILADELPHIA PA
19110
US

V. Phone/Fax

Practice location:
  • Phone: 215-701-1560
  • Fax: 215-701-1572
Mailing address:
  • Phone: 215-701-1560
  • Fax: 215-701-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number117040
License Number StatePA

VIII. Authorized Official

Name: DR. IVAN O HASKELL
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 215-701-1560