MEDICARE: VINCENT INTERSIMONE

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1790616753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT INTERSIMONE

Provider Business Mailing Address
First Line	:	449 W NORRIS ST APT 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2250
Country	:	US
Telephone Number	:	650-996-2037
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 BUSTLETON AVE STE 300
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3330
Country	:	US
Telephone Number	:	215-320-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ VINCENT INTERSIMONE ” Practice Location

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