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General NPI Number Information
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NPI Number | 1861088791
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA COUPLES THERAPY
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 123 S BROAD ST STE 2240
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City | PHILADELPHIA
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State | PA
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Zip | 19109-1029
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Country | US
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Telephone | 267-209-0140
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Fax |
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Provider Business Mailing Address
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Address Line | 2157 WOODLAWN AVE
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City | GLENSIDE
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State | PA
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Zip | 19038-5329
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Country | US
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Telephone | 703-216-5903
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANNA NICHOLAIDES
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Credential | PSY.D.
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Telephone | 267-702-6623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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