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General NPI Number Information
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NPI Number | 1770472524
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Entity Type | Organization
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Legal Business Name | AHYOUNG TAE, PSYD
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Dates
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Enumeration Date | 06/28/2025
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Last Update Date | 06/28/2025
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Provider Practice Location Address
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Address Line | 1315 WOLF ST UNIT 2
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2911
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Country | US
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Telephone | 267-688-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 WOLF ST UNIT 2
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2911
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Country | US
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Telephone | 267-688-2225
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | AHYOUNG TAE
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Credential | PSYD
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Telephone | 267-688-2225
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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 |
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License Number State |
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