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General NPI Number Information
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NPI Number | 1720308885
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Entity Type | Organization
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Legal Business Name | PROMOTING YOUTH EMPOWERMENT, INC
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 2521 W GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1313
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Country | US
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Telephone | 267-265-1767
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Fax |
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Provider Business Mailing Address
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Address Line | 220 FLAMINGO RD
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City | MARLTON
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State | NJ
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Zip | 08053-5106
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Country | US
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Telephone | 215-356-2043
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. THERESA A PRESCOTT
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Credential | DO
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Telephone | 215-356-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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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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