Provider Demographics
NPI:1952914897
Name:INTEGRATED PSYCHOTHERAPY & ASSESSMENT PRACTICE OF PENNSYLVANIA
Entity Type:Organization
Organization Name:INTEGRATED PSYCHOTHERAPY & ASSESSMENT PRACTICE OF PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-694-3912
Mailing Address - Street 1:405 S 62ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1031
Mailing Address - Country:US
Mailing Address - Phone:215-694-3912
Mailing Address - Fax:
Practice Address - Street 1:405 S 62ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1031
Practice Address - Country:US
Practice Address - Phone:215-694-3912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty