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General NPI Number Information
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NPI Number | 1750747416
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Entity Type | Organization
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Legal Business Name | WORDSWORTH
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 3300 HENRY AVE 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1121
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Country | US
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Telephone | 245-643-5400
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Fax | 267-529-1942
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Provider Business Mailing Address
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Address Line | 3300 HENRY AVE 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1121
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Country | US
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Telephone | 215-643-5400
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Fax | 267-529-1942
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. DEBRA LACKS
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Credential |
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Telephone | 215-643-5400
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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 | 100728361
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License Number State | PA
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