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General NPI Number Information
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NPI Number | 1598102246
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES OF CHESMONT, LLC.
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 506 S BETHLEHEM PIKE
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-2111
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Country | US
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Telephone | 267-419-8532
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Fax | 610-384-9571
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Provider Business Mailing Address
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Address Line | 506 S BETHLEHEM PIKE
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-2111
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Country | US
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Telephone | 267-419-8532
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Fax | 610-384-9571
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD PERRT JOHNSON
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Credential | PH.D.
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Telephone | 267-419-8532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS004933L
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License Number State | PA
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