MEDICARE: PHILADELPHIA AREA SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1598356206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA AREA SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	440 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-4015
Country	:	US
Telephone Number	:	215-681-6688
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-4015
Country	:	US
Telephone Number	:	215-681-6688
Fax Number	:

Authorized Official
Title or Position	:	DEPUTY CHIEF OF PREVENTION, INTERVE
Name	:	DR. JAYME BANKS
Credential	:	PSYD, MBA
Telephone Number	:	215-681-6688

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	01/27/2021

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