Provider Demographics
NPI:1568517134
Name:PSYCHOLOGICAL RESOURCE CENTER
Entity Type:Organization
Organization Name:PSYCHOLOGICAL RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-640-0600
Mailing Address - Street 1:1800 JOHN F KENNEDY BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7421
Mailing Address - Country:US
Mailing Address - Phone:215-640-0600
Mailing Address - Fax:215-640-0914
Practice Address - Street 1:1800 JOHN F KENNEDY BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19103-7421
Practice Address - Country:US
Practice Address - Phone:215-640-0600
Practice Address - Fax:215-640-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002036L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty