Provider Demographics
NPI:1255717500
Name:SARAH PULVER PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:SARAH PULVER PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:PULVER
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, MSW
Authorized Official - Phone:267-574-0009
Mailing Address - Street 1:4626 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4519
Mailing Address - Country:US
Mailing Address - Phone:267-574-0009
Mailing Address - Fax:
Practice Address - Street 1:440 E GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3326
Practice Address - Country:US
Practice Address - Phone:267-574-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131112305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization