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General NPI Number Information
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NPI Number | 1972695740
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Entity Type | Organization
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Legal Business Name | CHOP CLINICAL ASSOCIATES
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 4009 BLACK HORSE PIKE
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City | MAYS LANDING
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State | NJ
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Zip | 08330-3133
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Country | US
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Telephone | 215-590-7555
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Fax | 215-590-7387
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Provider Business Mailing Address
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Address Line | 3401 CIVIC CENTER BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 215-590-7555
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Fax |
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Authorized Official
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Title or Position | VP REVENUE CYCLE
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Name | MR. FABIAN STONE
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Credential |
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Telephone | 267-425-5765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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