Provider Demographics
NPI:1467547968
Name:THOMAS JEFFERSON UNIVERSITY
Entity Type:Organization
Organization Name:THOMAS JEFFERSON UNIVERSITY
Other - Org Name:THOMAS JEFFERSON UNIVERSITY DRUG AND ALCOHOL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-790-9942
Mailing Address - Street 1:1021 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2634
Mailing Address - Country:US
Mailing Address - Phone:215-790-9942
Mailing Address - Fax:215-790-8617
Practice Address - Street 1:1021 SOUTH 21ST STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146
Practice Address - Country:US
Practice Address - Phone:215-735-5979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS JEFFERSON UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X
PA820023251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007571300083OtherMEDICAID