Provider Demographics
NPI:1093867772
Name:PAN AMERICAN MENTAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:PAN AMERICAN MENTAL HEALTH SERVICES INC
Other - Org Name:PAN AMERICAN MENTAL HEALTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-457-1620
Mailing Address - Street 1:4519 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2309
Mailing Address - Country:US
Mailing Address - Phone:215-457-1620
Mailing Address - Fax:215-457-0350
Practice Address - Street 1:4519 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2309
Practice Address - Country:US
Practice Address - Phone:215-457-1620
Practice Address - Fax:215-457-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA195600261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA958072Medicare ID - Type Unspecified