Provider Demographics
NPI:1326027269
Name:PSYCHOLOGICAL SERVICES & HUMAN DEVELOPMENT CENTER, INC.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES & HUMAN DEVELOPMENT CENTER, INC.
Other - Org Name:PSHDC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-540-5860
Mailing Address - Street 1:220 COMMERCE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2402
Mailing Address - Country:US
Mailing Address - Phone:215-540-5860
Mailing Address - Fax:215-540-5864
Practice Address - Street 1:220 COMMERCE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2402
Practice Address - Country:US
Practice Address - Phone:215-540-5860
Practice Address - Fax:215-540-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA019977Medicare ID - Type Unspecified