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General NPI Number Information
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NPI Number | 1528171790
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Entity Type | Organization
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Legal Business Name | DR WARREN E SMITH COMMUNITY MENTAL HEALTH MENTAL RETARDATION & SUBSTAN
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1315 WINDRIM AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19141-2710
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Country | US
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Telephone | 215-456-2611
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Fax | 215-456-2729
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Provider Business Mailing Address
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Address Line | 1315 WINDRIM AVENUE DR WARREN E SMITH HEALTH CENTERS
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City | PHILADELPHIA
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State | PA
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Zip | 19141-2710
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Country | US
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Telephone | 215-456-2611
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Fax | 215-456-2729
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KENNETH GLASS
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Credential | PHD
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Telephone | 267-256-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 185300
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License Number State | PA
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