| NPI | 1366213597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN MONTGOMERY Billing/Credentialing Specialist 215-997-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2024-01-16 |
| Last Update Date | 2024-01-16 |