Healthcare Provider Details

I. General information

NPI: 1881952430
Provider Name (Legal Business Name): JEAN HAMPTON WOODS RNPMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 ARBORETUM RD
WYNCOTE PA
19095-2109
US

IV. Provider business mailing address

1013 ARBORETUM RD
WYNCOTE PA
19095-2109
US

V. Phone/Fax

Practice location:
  • Phone: 267-735-8374
  • Fax: 215-576-1039
Mailing address:
  • Phone: 267-735-8374
  • Fax: 215-576-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN122973L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: