Provider Demographics
NPI:1790101475
Name:PEARSON, JEANINE (MS)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E GLENOLDEN AVE APT T3
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-2240
Mailing Address - Country:US
Mailing Address - Phone:267-253-6247
Mailing Address - Fax:
Practice Address - Street 1:432 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4004
Practice Address - Country:US
Practice Address - Phone:215-925-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor