Provider Demographics
NPI:1003175670
Name:PHILADELPHIA SCHOOL OF PSYCHOANALYSIS
Entity Type:Organization
Organization Name:PHILADELPHIA SCHOOL OF PSYCHOANALYSIS
Other - Org Name:THE PHIL.CONSULTATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, NCPSYA
Authorized Official - Phone:215-732-8244
Mailing Address - Street 1:316 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4907
Mailing Address - Country:US
Mailing Address - Phone:215-732-8244
Mailing Address - Fax:215-732-8454
Practice Address - Street 1:316 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4907
Practice Address - Country:US
Practice Address - Phone:215-732-8244
Practice Address - Fax:215-732-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC0004614251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health