Healthcare Provider Details

I. General information

NPI: 1992889562
Provider Name (Legal Business Name): EMPOWERMENT RESOURCE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 SPRING GARDEN ST FL 2
PHILADELPHIA PA
19130-3915
US

IV. Provider business mailing address

1733 SPRING GARDEN ST FL 2
PHILADELPHIA PA
19130-3915
US

V. Phone/Fax

Practice location:
  • Phone: 215-564-0680
  • Fax: 215-564-0680
Mailing address:
  • Phone: 215-564-0680
  • Fax: 215-564-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number132910
License Number StatePA

VIII. Authorized Official

Name: MRS. JUDY HENDERSON
Title or Position: EXECTIVE DIRECTOR AND PRESIDENT
Credential: MHS, MS
Phone: 215-564-0680