Provider Demographics
NPI:1235527177
Name:JPA CENTER FOR INTEGRATIVE HEALTH, LLC
Entity Type:Organization
Organization Name:JPA CENTER FOR INTEGRATIVE HEALTH, LLC
Other - Org Name:JENKINTOWN PSYCHOLOGICAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MONTANARO
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:215-885-1252
Mailing Address - Street 1:601 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3238
Mailing Address - Country:US
Mailing Address - Phone:215-885-1252
Mailing Address - Fax:
Practice Address - Street 1:601 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3238
Practice Address - Country:US
Practice Address - Phone:215-885-1252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-09-5329103K00000X
PAPS016264103T00000X
PACW0162391041C0700X
PACW0166891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty