Provider Demographics
NPI:1710113782
Name:PHILADELPHIA MENTAL HEALTH
Entity Type:Organization
Organization Name:PHILADELPHIA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BSC/MT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:215-900-0891
Mailing Address - Street 1:519 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-5018
Mailing Address - Country:US
Mailing Address - Phone:610-622-0055
Mailing Address - Fax:
Practice Address - Street 1:1235 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5945
Practice Address - Country:US
Practice Address - Phone:215-735-7068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23522950251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health