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General NPI Number Information
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NPI Number | 1730482886
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Entity Type | Organization
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Legal Business Name | PHILADELPHIAL MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 1235 PINE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5945
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Country | US
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Telephone | 215-735-7068
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Fax |
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Provider Business Mailing Address
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Address Line | 519 GLENDALE RD
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City | UPPER DARBY
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State | PA
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Zip | 19082-5018
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Country | US
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Telephone | 215-900-0891
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Fax |
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Authorized Official
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Title or Position | BSC/ MT
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Name | MS. KIA MICHELE HUNTER
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Credential | M. S.
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Telephone | 215-900-0891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 251S0000X
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License Number State | PA
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