Provider Demographics
NPI:1356454045
Name:EQUILIBRIA PSYCHOLOGICAL AND CONSULTATION SERVICES, LLC
Entity Type:Organization
Organization Name:EQUILIBRIA PSYCHOLOGICAL AND CONSULTATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:LIPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MBA
Authorized Official - Phone:267-861-3685
Mailing Address - Street 1:525 S 4TH ST
Mailing Address - Street 2:SUITE 471
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1570
Mailing Address - Country:US
Mailing Address - Phone:267-861-3685
Mailing Address - Fax:215-965-1513
Practice Address - Street 1:525 S 4TH ST
Practice Address - Street 2:SUITE 471
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1570
Practice Address - Country:US
Practice Address - Phone:267-861-3685
Practice Address - Fax:215-965-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015446103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty