MEDICARE: WMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	192780	PA
2	101YP2500X	Professional Counselor	192780	PA
3	103TC0700X	Clinical Psychologist	192780	PA
4	174400000X	Specialist	192780	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114144508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WMC

Provider Business Mailing Address
First Line	:	4913 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2215
Country	:	US
Telephone Number	:	215-329-3200
Fax Number	:	215-329-3217

Provider Business Practice Location Address
First Line	:	4913 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2215
Country	:	US
Telephone Number	:	215-329-3200
Fax Number	:	215-329-3217

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	MRS. TAKISA S GALLMAN
Credential	:
Telephone Number	:	215-276-3922

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	09/11/2025

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Directions to “WMC ” Practice Location

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