MEDICARE: EVERGREEN COUNSELING ASSOCIATES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	1041C0700X	Clinical Social Worker
3	2084P0800X	Psychiatry Physician
4	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2317336000	OTHER	PA	PERSONAL CHOICE
2	5537312	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1184787137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN COUNSELING ASSOCIATES

Provider Business Mailing Address
First Line	:	7600 STENTON AVE
Second Line	:	SUITE 1F
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3231
Country	:	US
Telephone Number	:	215-247-5400
Fax Number	:	215-247-5175

Provider Business Practice Location Address
First Line	:	7600 STENTON AVE
Second Line	:	SUITE 1F
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3231
Country	:	US
Telephone Number	:	215-247-5400
Fax Number	:	215-247-5175

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ANDREW R. VOGELSON
Credential	:	PH.D.
Telephone Number	:	215-247-5400

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/28/2013

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Directions to “EVERGREEN COUNSELING ASSOCIATES ” Practice Location

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