Provider Demographics
NPI:1750970802
Name:WEST PHILLY THERAPY CENTER
Entity type:Organization
Organization Name:WEST PHILLY THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:215-514-5766
Mailing Address - Street 1:5050 BALTIMORE AVE UNIT 14
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3302
Mailing Address - Country:US
Mailing Address - Phone:267-209-3130
Mailing Address - Fax:
Practice Address - Street 1:5050 BALTIMORE AVE UNIT 14
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3302
Practice Address - Country:US
Practice Address - Phone:267-209-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty