| Joseph J. Peters Institute | |
|
100 South Broad Street 17th Floor Philadelphia PA 19110 | |
| (215) 701-1560 | |
| (215) 701-1572 |
| Full Name | Joseph J. Peters Institute |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 100 South Broad Street, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Theodore E. Glackman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2157011560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joseph J. Peters Institute 100 South Broad Street 17th Floor Philadelphia PA 19110 Ph: (215) 701-1560 | Joseph J. Peters Institute 100 South Broad Street 17th Floor Philadelphia PA 19110 Ph: (215) 701-1560 |
| NPI Number | 1023177144 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0749263697 |
|---|---|
| Medicare Enrollment ID | O20040610001548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023177144 | NPI | - | NPPES |
| 1007562120008 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 117040 (Pennsylvania) | Primary |
| Provider Name | Donald Kushon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730174756 PECOS PAC ID: 5597747261 Enrollment ID: I20071120000133 |
| Provider Name | David M Harwitz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760541098 PECOS PAC ID: 3971651712 Enrollment ID: I20090504000622 |
| Provider Name | Jessica N Shore |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225284516 PECOS PAC ID: 6800035189 Enrollment ID: I20130618000019 |
| Provider Name | Melissa Gonska |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912244062 PECOS PAC ID: 9436416633 Enrollment ID: I20171127000157 |
| Provider Name | Stephen J Sell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366959488 PECOS PAC ID: 8820358856 Enrollment ID: I20180212001673 |
| Provider Name | Maxwell B Wagenknecht |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306297015 PECOS PAC ID: 9335488428 Enrollment ID: I20190307002054 |
| Provider Name | Sean M Pepley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750847331 PECOS PAC ID: 0345580775 Enrollment ID: I20190322000057 |
| Provider Name | Avery Axel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922534619 PECOS PAC ID: 6709210297 Enrollment ID: I20191216000916 |
| Provider Name | Ademola O Fawole |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871080358 PECOS PAC ID: 7618216151 Enrollment ID: I20201020001618 |
| Provider Name | Julia Vayner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932773538 PECOS PAC ID: 8022427392 Enrollment ID: I20210518000389 |
| Provider Name | Adam Joseph Rzepka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548879836 PECOS PAC ID: 5799131777 Enrollment ID: I20231026004187 |
| Provider Name | Kelly T O'neill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881463107 PECOS PAC ID: 9638512973 Enrollment ID: I20240203000321 |
| Provider Name | Madison Macintosh |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215651575 PECOS PAC ID: 3971942251 Enrollment ID: I20240419000322 |
| Provider Name | Maria J Delgado |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083478010 PECOS PAC ID: 5991144289 Enrollment ID: I20240419000584 |
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