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General NPI Number Information
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NPI Number | 1811010093
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Entity Type | Organization
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Legal Business Name | GREEN TREE SCHOOL
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 146 W WALNUT LN
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2612
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Country | US
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Telephone | 215-843-4528
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Fax | 215-843-2688
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Provider Business Mailing Address
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Address Line | PO BOX 25639
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City | PHILADELPHIA
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State | PA
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Zip | 19144-0639
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Country | US
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Telephone | 215-843-4528
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Fax | 215-843-2688
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. HERMAN AXELROD
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Credential | PHD
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Telephone | 215-843-4528
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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 | 121810
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License Number State | PA
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