Provider Demographics
NPI:1558402545
Name:FAMILY HEALTH PSYCHOLOGY CENTER
Entity Type:Organization
Organization Name:FAMILY HEALTH PSYCHOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-524-1552
Mailing Address - Street 1:506 W MOUNT AIRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2948
Mailing Address - Country:US
Mailing Address - Phone:610-237-5444
Mailing Address - Fax:
Practice Address - Street 1:506 W MOUNT AIRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2948
Practice Address - Country:US
Practice Address - Phone:610-237-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0278173000OtherPERSONAL CHOICE
PA10076199650006Medicaid
PACI9140OtherRAILROAD MEDICARE
PA7761157OtherAETNA
PA726664Medicare ID - Type Unspecified