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General NPI Number Information
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NPI Number | 1487667978
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF PENN PSYCHIATRY
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 3400 SPRUCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4206
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Country | US
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Telephone | 866-301-4724
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Fax | 215-662-7200
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Provider Business Mailing Address
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Address Line | 3624 MARKET ST SUITE 560W
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2614
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Country | US
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Telephone | 215-662-7583
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ELIZABETH JOHNSTON
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Credential |
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Telephone | 215-662-7583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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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 | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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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 | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State | PA
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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