Provider Demographics
NPI:1063829232
Name:LADIPO GROUP PSYCHOTHERAPY FOR OUR COMMUNITY LLC
Entity Type:Organization
Organization Name:LADIPO GROUP PSYCHOTHERAPY FOR OUR COMMUNITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LADIPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-908-6363
Mailing Address - Street 1:255 S 17TH ST STE 2704
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6228
Mailing Address - Country:US
Mailing Address - Phone:267-908-6363
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 2704
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6228
Practice Address - Country:US
Practice Address - Phone:267-908-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0154091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty