Provider Demographics
NPI:1265547160
Name:PATH (PEOPLE ACTING TO HELP), INC
Entity type:Organization
Organization Name:PATH (PEOPLE ACTING TO HELP), INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:VARELA
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:215-728-4597
Mailing Address - Street 1:1919 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3816
Mailing Address - Country:US
Mailing Address - Phone:215-728-4600
Mailing Address - Fax:
Practice Address - Street 1:1919 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3816
Practice Address - Country:US
Practice Address - Phone:215-728-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
PA121680261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001584Medicaid
PA823003 SUFFIX LFNMedicare ID - Type UnspecifiedLICENSED PSYCHOLOG/LCSW
PA089180 SUFFIX E6UMedicare ID - Type UnspecifiedPSYCHIATRIST GROUP