NPI 1952570558 · live from the CMS NPI Registry
Advanced Behavioral Health
Psychologist in Philadelphia, PA. National Provider Identifier 1952570558, active.
NPI record
| NPI | 1952570558 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Psychologist 103T00000X |
| Practice location | 2109 Red Lion Rd, Philadelphia, PA 19115 |
| Practice phone | 732-901-0035 |
| Mailing address | 681 River Ave Ste 2e, Lakewood, NJ 08701 |
| Enumerated | February 27, 2008 |
| Last updated | June 4, 2008 |
| Authorized official | Issac Gelley, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Social Worker | 104100000X | — |
| Nurse Practitioner | 363L00000X | — |
| Psychologist primary | 103T00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.