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General NPI Number Information
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NPI Number | 1023177144
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Entity Type | Organization
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Legal Business Name | JOSEPH J. PETERS INSTITUTE
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 100 SOUTH BROAD STREET 17TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19110
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Country | US
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Telephone | 215-701-1560
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Fax | 215-701-1572
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Provider Business Mailing Address
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Address Line | 100 SOUTH BROAD STREET 17TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19110
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Country | US
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Telephone | 215-701-1560
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Fax | 215-701-1572
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. IVAN O HASKELL
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Credential | PH.D.
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Telephone | 215-701-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 117040
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License Number State | PA
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