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General NPI Number Information
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NPI Number | 1700395894
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Entity Type | Organization
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Legal Business Name | POSITIVE MIND AND BODY, LLC
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 09/21/2017
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Provider Practice Location Address
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Address Line | 110 BALA AVE. 3RD FLOOR SUITE
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City | BALA CYNWYD
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State | PA
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Zip | 19004
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Country | US
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Telephone | 484-406-5047
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Fax | 610-664-1726
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Provider Business Mailing Address
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Address Line | 110 BALA AVE. 3RD FLOOR SUITE
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City | BALA CYNWYD
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State | PA
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Zip | 19004
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Country | US
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Telephone | 484-406-5047
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Fax | 610-664-1726
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Authorized Official
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Title or Position | COFOUNDER, PSYCHIATRIST
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Name | DR. LYDIA KAY SIT
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Credential | M.D.
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Telephone | 856-553-7748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC009417
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS018049
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PC009417
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License Number State | PA
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