Provider Demographics
NPI:1750747416
Name:WORDSWORTH
Entity type:Organization
Organization Name:WORDSWORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-643-5400
Mailing Address - Street 1:3300 HENRY AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1121
Mailing Address - Country:US
Mailing Address - Phone:215-643-5400
Mailing Address - Fax:267-529-1942
Practice Address - Street 1:3300 HENRY AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1121
Practice Address - Country:US
Practice Address - Phone:245-643-5400
Practice Address - Fax:267-529-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100728361251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1932242864OtherCOMMUNITY BEHAVIORAL HEALTH
PA1801203567OtherCOMMUNITY BEHAVIORAL HEALTH
PA1114060043OtherCOMMUNITY BEHAVIORAL HEALTH
PA1407806433OtherCOMMUNITY BEHAVIORAL HEALTH
PA1669514774OtherCOMMUNITY BEHAVIORAL HEALTH
PA1477695542OtherCOMMUNITY BEHAVIORAL HEALTH
PA1942342878OtherCOMMUNITY BEHAVIORAL HEALTH
PA1588008643OtherCOMMUNITY BEHAVIORAL HEALTH
PA1841333770OtherCOMMUNITY BEHAVIORAL HEALTH
PA1295877314OtherCOMMUNITY BEHAVIORAL HEALTH