| John F Kennedy Community Mh Mr Center | |
|
112 N Broad St Rm 821 Philadelphia PA 19102-1510 | |
| (215) 568-0622 | |
| (215) 568-0769 |
| Full Name | John F Kennedy Community Mh Mr Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 112 N Broad St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Alice G Young (VICE PRESIDENT - FINANCE) |
| Authorized Official Contact | 2155680622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John F Kennedy Community Mh Mr Center 112 N Broad St Rm 821 Philadelphia PA 19102-1510 Ph: (215) 568-0622 | John F Kennedy Community Mh Mr Center 112 N Broad St Rm 821 Philadelphia PA 19102-1510 Ph: (215) 568-0622 |
| NPI Number | 1942359120 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 10/15/2013 |
| Medicare PECOS PAC ID | 4284535196 |
|---|---|
| Medicare Enrollment ID | O20040114000697 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942359120 | NPI | - | NPPES |
| 1000034530014 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 122000 (Pennsylvania) | Primary |
| Provider Name | Joseph K Stanilla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154365138 PECOS PAC ID: 0840270229 Enrollment ID: I20040726000207 |
| Provider Name | Buster Deangelo Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932290251 PECOS PAC ID: 3971554791 Enrollment ID: I20050209000089 |
| Provider Name | Thomas Holdbrook |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942389762 PECOS PAC ID: 2163527136 Enrollment ID: I20070419000449 |
| Provider Name | Sunny F Ekwunife |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811197064 PECOS PAC ID: 1456440304 Enrollment ID: I20071130000250 |
| Provider Name | Khadija S Ola |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891970950 PECOS PAC ID: 5991886558 Enrollment ID: I20080122000071 |
| Provider Name | Kevin G Huang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831378975 PECOS PAC ID: 8527147883 Enrollment ID: I20080512000497 |
| Provider Name | M Samson Seplow |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477686608 PECOS PAC ID: 0446323125 Enrollment ID: I20080715000284 |
| Provider Name | James J Nocks |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548203425 PECOS PAC ID: 0345318325 Enrollment ID: I20081003000293 |
| Provider Name | Rosilyn T Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184715013 PECOS PAC ID: 0446252571 Enrollment ID: I20090421000654 |
| Provider Name | Marja Elina Mattila-evenden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750552089 PECOS PAC ID: 0749316610 Enrollment ID: I20100331000140 |
| Provider Name | Howard N Brooks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336277458 PECOS PAC ID: 2163608357 Enrollment ID: I20110524000717 |
| Provider Name | Adrian Lashone Harewood |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1588985550 PECOS PAC ID: 4587809363 Enrollment ID: I20130327000260 |
| Provider Name | Phyllis J Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225320245 PECOS PAC ID: 5092992321 Enrollment ID: I20131212000100 |
| Provider Name | Rachel Bennett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194989814 PECOS PAC ID: 4284857723 Enrollment ID: I20140602000477 |
| Provider Name | Abraham S Pachikara |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699939256 PECOS PAC ID: 0749412773 Enrollment ID: I20150626000717 |
| Provider Name | Tana E Andre |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992052120 PECOS PAC ID: 6709014244 Enrollment ID: I20160706002450 |
| Provider Name | Alexandre Geronian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548443906 PECOS PAC ID: 4789762675 Enrollment ID: I20160816000131 |
| Provider Name | Christopher Verica |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386736627 PECOS PAC ID: 6709815400 Enrollment ID: I20180201002147 |
| Provider Name | Amy Huang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326358953 PECOS PAC ID: 8729348735 Enrollment ID: I20180213002377 |
| Provider Name | Muhammad A Naz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780977421 PECOS PAC ID: 2466627740 Enrollment ID: I20181005000275 |
| Provider Name | Tajudeen Adebayo Kolawole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861091191 PECOS PAC ID: 3870904584 Enrollment ID: I20201202001173 |
| Provider Name | Kutaiba Salem Chaleby |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871576736 PECOS PAC ID: 1759564750 Enrollment ID: I20210421000627 |
| Provider Name | Trevor Henry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235659277 PECOS PAC ID: 3870863137 Enrollment ID: I20210821000316 |
| Provider Name | Victoria A Conn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699925081 PECOS PAC ID: 8921492935 Enrollment ID: I20220308000598 |
Solis Physicians Network Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5800 Ridge Ave, Philadelphia, PA 19128 Phone: 215-487-4692 Fax: 215-487-4274 | |
Apm Mental Health Psychiatric Outpatient Clinics Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2921 N 5th St, Philadelphia, PA 19133 Phone: 215-259-3373 Fax: 267-329-9728 | |
University Of Pennsylvania Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3400 Civic Center Blvd, 2 South Pavilion, Philadelphia, PA 19104 Phone: 215-614-1828 | |
The Phil.consultation Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 316 S 16th St, Philadelphia, PA 19102 Phone: 215-732-8244 Fax: 215-732-8454 | |
Immanuel Care Support Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6641 Dorel St, Philadelphia, PA 19142 Phone: 267-403-8313 | |
Npsyt Psychological Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6327 Burbridge St, Philadelphia, PA 19144 Phone: 215-991-9066 Fax: 215-991-9062 | |
Menergy, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 7500 Germantown Ave, New Covenant Campus, Elders Hall, Suite 5, Philadelphia, PA 19119 Phone: 215-242-2235 |