Provider Demographics
NPI:1952360877
Name:THERAPY CENTER OF PHILADELPHIA
Entity Type:Organization
Organization Name:THERAPY CENTER OF PHILADELPHIA
Other - Org Name:WOMEN'S THERAPY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:E
Authorized Official - Last Name:GERIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:215-567-1111
Mailing Address - Street 1:1315 WALNUT STREET
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4721
Mailing Address - Country:US
Mailing Address - Phone:215-567-1111
Mailing Address - Fax:215-567-0179
Practice Address - Street 1:1315 WALNUT STREET
Practice Address - Street 2:SUITE 1004
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4721
Practice Address - Country:US
Practice Address - Phone:215-567-1111
Practice Address - Fax:215-567-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W0177336OtherBLUE CROSS BLUE SHIELD