Provider Demographics
NPI:1558320622
Name:JERUCHIM, JOAN DORIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:DORIS
Last Name:JERUCHIM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MARKET ST UNIT 3203
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1367
Mailing Address - Country:US
Mailing Address - Phone:610-644-7415
Mailing Address - Fax:775-719-4764
Practice Address - Street 1:2101 MARKET ST UNIT 3203
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:610-644-7415
Practice Address - Fax:775-719-4764
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-008612-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1260848OtherMULTI-PLAN
PA4335760OtherAETNA, NON-HMO
PA230139000OtherIBC - KEYSTONE
PA186977OtherMANAGED HEALTH NETWORK
PA0026111000OtherIBC - PERSONAL CHOICE
PA1760255OtherCOMPSYCH BH CORP
PAP3264689OtherOXFORD
PA001661854OtherHIGHMARK BLUE SHIELD
PAJE339389OtherHIGHMARK BS - PA BS
PA4335760OtherAETNA, HMO
PA230139000OtherMAGELLAN HEALTH SERVICES