Provider Demographics
NPI:1013627827
Name:CENTER FOR COGNITIVE BEHAVIORAL THERAPY AND MINDFULNESS
Entity Type:Organization
Organization Name:CENTER FOR COGNITIVE BEHAVIORAL THERAPY AND MINDFULNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER AND DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SURAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:844-287-4228
Mailing Address - Street 1:3720 SPRUCE ST STE 409
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1802 GREEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-4020
Practice Address - Country:US
Practice Address - Phone:844-287-4228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty