Provider Demographics
NPI:1124393681
Name:CENTER CITY PSYCHOLOGY, PC
Entity Type:Organization
Organization Name:CENTER CITY PSYCHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOUR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:215-688-1702
Mailing Address - Street 1:210 LOCUST ST
Mailing Address - Street 2:15B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3934
Mailing Address - Country:US
Mailing Address - Phone:215-928-2019
Mailing Address - Fax:
Practice Address - Street 1:100 S BROAD ST
Practice Address - Street 2:SUITE 1215
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1023
Practice Address - Country:US
Practice Address - Phone:215-688-1702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty