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General NPI Number Information
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NPI Number | 1972273431
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Entity Type | Organization
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Legal Business Name | INSPIRED AND FREE
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 1300 S COLUMBUS BLVD STE 1044
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City | PHILADELPHIA
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State | PA
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Zip | 19147-5529
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Country | US
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Telephone | 484-301-0870
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 JEFFERSON AVE
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City | WOODLYN
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State | PA
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Zip | 19094-1313
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Country | US
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Telephone | 215-459-1613
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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. DALESA MARTINEZ
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Credential | PHD.
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Telephone | 484-301-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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