Provider Demographics
NPI:1609200567
Name:PROFESSIONAL PSYCHOLOGY SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL PSYCHOLOGY SERVICES
Other - Org Name:JOHN FRANCIS GOLDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-545-7895
Mailing Address - Street 1:250 S 17TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6336
Mailing Address - Country:US
Mailing Address - Phone:215-545-7895
Mailing Address - Fax:215-545-7870
Practice Address - Street 1:1 N MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2445
Practice Address - Country:US
Practice Address - Phone:609-929-2544
Practice Address - Fax:215-545-7870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00061000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty