=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356758221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILADELPHIA ASSESSMENT & COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2014
-----------------------------------------------------
Last Update Date | 06/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2133 ARCH ST SUITE 302
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19103-1350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-285-6291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2133 ARCH ST SUITE 302
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19103-1350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-285-6291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RAQUEL A ROMIROWSKY
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 215-285-6291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PS016435
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------