Healthcare Provider Details

I. General information

NPI: 1952360877
Provider Name (Legal Business Name): THERAPY CENTER OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S BROAD ST STE 302
PHILADELPHIA PA
19107-5325
US

IV. Provider business mailing address

215 S BROAD ST STE 302
PHILADELPHIA PA
19107-5325
US

V. Phone/Fax

Practice location:
  • Phone: 215-567-1111
  • Fax: 223-233-0356
Mailing address:
  • Phone: 215-567-1111
  • Fax: 223-233-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARQUITA BOLDEN
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LCSW, RSW
Phone: 215-567-1111