Provider Demographics
NPI:1477645232
Name:CHILDREN'S HOSPITAL OF PHILADELPHIA PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF PHILADELPHIA PRACTICE ASSOCIATES
Other - Org Name:CHOP BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REV CYCLE & REIM STRATEGY
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-426-6179
Mailing Address - Street 1:3440 MARKET ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3325
Mailing Address - Country:US
Mailing Address - Phone:215-590-7532
Mailing Address - Fax:215-590-4251
Practice Address - Street 1:3440 MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3325
Practice Address - Country:US
Practice Address - Phone:215-590-7555
Practice Address - Fax:215-590-7387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL OF PHILADELPHIA PRACTICE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty