MEDICARE: THE CHILDRENS HOSPITAL OF PHILADELPHIA PRACTICE ASSOCIATION

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	103G00000X	Clinical Neuropsychologist
3	103T00000X	Psychologist
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	1041C0700X	Clinical Social Worker
6	2084P0800X	Psychiatry Physician
7	101YP2500X	Professional Counselor
8	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1477645232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHILDRENS HOSPITAL OF PHILADELPHIA PRACTICE ASSOCIATION

Provider Business Mailing Address
First Line	:	3401 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4319
Country	:	US
Telephone Number	:	215-590-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 MARKET ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-4636
Country	:	US
Telephone Number	:	215-590-7555
Fax Number	:	215-590-7555

Authorized Official
Title or Position	:	EVP & CHIEF FINANCIAL OFFICER
Name	:	SOPHIA G HOLDER
Credential	:
Telephone Number	:	267-426-6022

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	09/18/2025

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