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General NPI Number Information
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NPI Number | 1316096753
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Entity Type | Organization
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Legal Business Name | NORTHEAST COMMUNITY CENTER FOR MENTAL HEALTH & MENTAL RETARDATION
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7226 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1108
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Country | US
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Telephone | 215-742-7820
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Fax | 215-742-7808
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Provider Business Mailing Address
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Address Line | 4641 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2343
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Country | US
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Telephone | 215-831-2800
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Fax | 215-831-2929
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | HOWARD J KAUFMAN
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Credential |
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Telephone | 215-831-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 188220
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 188220
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 188220
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License Number State | PA
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