Provider Demographics
NPI:1952360877
Name:THERAPY CENTER OF PHILADELPHIA
Entity type:Organization
Organization Name:THERAPY CENTER OF PHILADELPHIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, RSW
Authorized Official - Phone:215-567-1111
Mailing Address - Street 1:215 S BROAD ST STE 302
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5325
Mailing Address - Country:US
Mailing Address - Phone:215-567-1111
Mailing Address - Fax:223-233-0356
Practice Address - Street 1:215 S BROAD ST STE 302
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5325
Practice Address - Country:US
Practice Address - Phone:215-567-1111
Practice Address - Fax:223-233-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W0177336OtherBLUE CROSS BLUE SHIELD