Provider Demographics
NPI:1477679546
Name:ADVANCED THERAPY INTERVENTION
Entity Type:Organization
Organization Name:ADVANCED THERAPY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEREO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-922-3040
Mailing Address - Street 1:221 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1215
Mailing Address - Country:US
Mailing Address - Phone:215-922-3040
Mailing Address - Fax:215-625-9632
Practice Address - Street 1:221 VINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1215
Practice Address - Country:US
Practice Address - Phone:215-922-3040
Practice Address - Fax:215-625-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000394-1103TP0814X
PAPS4431-L103TP0814X
VT098-0000066103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty