Provider Demographics
NPI:1598102246
Name:PSYCHOLOGICAL SERVICES OF CHESMONT, LLC.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF CHESMONT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PERRT
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:267-419-8532
Mailing Address - Street 1:506 S BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2111
Mailing Address - Country:US
Mailing Address - Phone:267-419-8532
Mailing Address - Fax:610-384-9571
Practice Address - Street 1:506 S BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2111
Practice Address - Country:US
Practice Address - Phone:267-419-8532
Practice Address - Fax:610-384-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004933L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1457329161Medicare UPIN