| Intercommunity Action, Inc | |
|
6122 Ridge Ave Phila PA 19128-1603 | |
| (215) 487-1330 | |
| Not Available |
| Full Name | Intercommunity Action, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 6122 Ridge Ave, Phila, Pennsylvania |
| Authorized Official Name and Position | David Bolin (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2154870906 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intercommunity Action, Inc 6012 Ridge Ave Phila PA 19128-1643 Ph: (215) 487-0906 | Intercommunity Action, Inc 6122 Ridge Ave Phila PA 19128-1603 Ph: (215) 487-1330 |
| NPI Number | 1730224445 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 03/06/2008 |
| Medicare PECOS PAC ID | 2961499579 |
|---|---|
| Medicare Enrollment ID | O20040427000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730224445 | NPI | - | NPPES |
| 1000008360083 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Frances A Meehan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740257864 PECOS PAC ID: 7214945500 Enrollment ID: I20060328000716 |
| Provider Name | Delane Casiano |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285790048 PECOS PAC ID: 7214027218 Enrollment ID: I20071214000022 |
| Provider Name | Erica M Brendel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861676801 PECOS PAC ID: 2062593098 Enrollment ID: I20080116000383 |
| Provider Name | Monika M Wysong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760532154 PECOS PAC ID: 1052488970 Enrollment ID: I20080918000477 |
| Provider Name | Samar A Jasser |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881750552 PECOS PAC ID: 4789739509 Enrollment ID: I20090831000646 |
| Provider Name | Brian K Long |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538246814 PECOS PAC ID: 8123033057 Enrollment ID: I20130612000134 |
| Provider Name | Deepraj Singh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417258948 PECOS PAC ID: 9739315268 Enrollment ID: I20131111001550 |
| Provider Name | William D La Valle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487038972 PECOS PAC ID: 1052605565 Enrollment ID: I20160805001860 |
| Provider Name | Michael P Gray |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891865382 PECOS PAC ID: 6608162326 Enrollment ID: I20160907000859 |
| Provider Name | Charles A Wisniewski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770997587 PECOS PAC ID: 8123382975 Enrollment ID: I20180503001229 |
| Provider Name | Darnell M Lorick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679081095 PECOS PAC ID: 8426313701 Enrollment ID: I20180607002835 |
| Provider Name | Matthew Donald Mcclure |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457746760 PECOS PAC ID: 0143574665 Enrollment ID: I20190715000000 |
| Provider Name | Tara Drames |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366826604 PECOS PAC ID: 1658706833 Enrollment ID: I20200116000073 |
| Provider Name | Kirsten Knoblauch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033818083 PECOS PAC ID: 3072956861 Enrollment ID: I20240208002657 |
| Provider Name | Sebastian Rimehaug |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073381844 PECOS PAC ID: 0941643746 Enrollment ID: I20240208002786 |
| Provider Name | Molly Reeves |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720694318 PECOS PAC ID: 6507200367 Enrollment ID: I20240220002710 |
Intercommunity Action, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4667 Umbria St, Phila, PA 19127 Phone: 215-508-6710 | |
S.g. Isaacs Enterprises, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 823 Magee Ave, Phila, PA 19111 Phone: 215-342-8690 | |
Intercommunity Action, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Salaignac St, Phila, PA 19128 Phone: 215-487-1330 | |
Inrercommunity Action, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3401 N Broad St, Temple Clinic, Phila, PA 19140 Phone: 215-487-1330 | |
Sami Khella Md Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 51 N 39th St # Mob320, Phila, PA 19104 Phone: 215-387-2052 Fax: 215-222-1856 | |
Intercommunity Action, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3500 Midvale Ave, Phila, PA 19129 Phone: 215-487-1330 | |
Intercommunity Action, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1526 Fairmount Ave, Phila, PA 19130 Phone: 215-487-1330 |