Provider Demographics
NPI:1396888350
Name:THOMAS JEFFERSON UNIVERSITY OUTREACH
Entity type:Organization
Organization Name:THOMAS JEFFERSON UNIVERSITY OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, DIV OF SUBSTANCE ABUSE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-955-7910
Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:SUITE 210-E
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:215-955-2542
Mailing Address - Fax:215-503-2850
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:SUITE 210-E
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-955-2542
Practice Address - Fax:215-503-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA820023251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare