Provider Demographics
NPI:1659569135
Name:INTERFACE PSYCH SERVICES, INC
Entity Type:Organization
Organization Name:INTERFACE PSYCH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:215-886-5331
Mailing Address - Street 1:349 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2908
Mailing Address - Country:US
Mailing Address - Phone:215-886-5331
Mailing Address - Fax:215-576-5949
Practice Address - Street 1:349 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2908
Practice Address - Country:US
Practice Address - Phone:215-886-5331
Practice Address - Fax:215-576-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty