| Philadelphia Psychotherapy Group | |
|
1518 Walnut St Ste 900 Philadelphia PA 19102 | |
| (215) 720-4800 | |
| Not Available |
| Full Name | Philadelphia Psychotherapy Group |
|---|---|
| Speciality | Social Worker |
| Location | 1518 Walnut St Ste 900, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Nicole Grossman (OWNER) |
| Authorized Official Contact | 2157204800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Philadelphia Psychotherapy Group 1518 Walnut St Ste 900 Philadelphia PA 19102-3405 Ph: (215) 720-4800 | Philadelphia Psychotherapy Group 1518 Walnut St Ste 900 Philadelphia PA 19102 Ph: (215) 720-4800 |
| NPI Number | 1144744574 |
|---|---|
| Provider Enumeration Date | 07/27/2017 |
| Last Update Date | 07/02/2018 |
| Medicare PECOS PAC ID | 4789942863 |
|---|---|
| Medicare Enrollment ID | O20171219000716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144744574 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CW017668 (Pennsylvania) | Primary |
| Provider Name | Nicole Grossman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497033823 PECOS PAC ID: 2961620729 Enrollment ID: I20140820001895 |
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