Provider Demographics
NPI:1972273431
Name:INSPIRED AND FREE
Entity Type:Organization
Organization Name:INSPIRED AND FREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:484-301-0870
Mailing Address - Street 1:1111 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1313
Mailing Address - Country:US
Mailing Address - Phone:215-459-1613
Mailing Address - Fax:
Practice Address - Street 1:1300 S COLUMBUS BLVD STE 1044
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-5529
Practice Address - Country:US
Practice Address - Phone:484-301-0870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1457980187OtherNPI