MEDICARE: THERAPY CENTER OF PHILADELPHIA

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1952360877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY CENTER OF PHILADELPHIA

Provider Business Mailing Address
First Line	:	215 S BROAD ST STE 302
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5325
Country	:	US
Telephone Number	:	215-567-1111
Fax Number	:	223-233-0356

Provider Business Practice Location Address
First Line	:	215 S BROAD ST STE 302
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5325
Country	:	US
Telephone Number	:	215-567-1111
Fax Number	:	223-233-0356

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARQUITA BOLDEN
Credential	:	MSW, LCSW, RSW
Telephone Number	:	215-567-1111

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	05/06/2025

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Directions to “THERAPY CENTER OF PHILADELPHIA ” Practice Location

Language	Start Address	Practice Location

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