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General NPI Number Information
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NPI Number | 1396888350
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Entity Type | Organization
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Legal Business Name | THOMAS JEFFERSON UNIVERSITY
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 833 CHESTNUT ST SUITE 210-E
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4414
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Country | US
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Telephone | 215-955-2542
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Fax | 215-503-2850
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Provider Business Mailing Address
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Address Line | 833 CHESTNUT ST STE 210E
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4405
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Country | US
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Telephone | 215-890-6277
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Fax | 215-790-9947
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SARA M SHANE
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Credential | PSY.D.
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Telephone | 215-890-6289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 820023
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License Number State | PA
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