| Phyllis H. Goltra, P.c. | |
|
1616 Walnut St Suite 1616 Philadelphia PA 19103-5313 | |
| (215) 545-8441 | |
| (215) 985-1129 |
| Full Name | Phyllis H. Goltra, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1616 Walnut St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Phyllis H. Goltra (PRESIDENT) |
| Authorized Official Contact | 2155458441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phyllis H. Goltra, P.c. 1616 Walnut St Suite 1616 Philadelphia PA 19103-5313 Ph: (215) 545-8441 | Phyllis H. Goltra, P.c. 1616 Walnut St Suite 1616 Philadelphia PA 19103-5313 Ph: (215) 545-8441 |
| NPI Number | 1164487500 |
|---|---|
| Provider Enumeration Date | 04/19/2006 |
| Last Update Date | 06/01/2009 |
| Medicare PECOS PAC ID | 3779639489 |
|---|---|
| Medicare Enrollment ID | O20090922000501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164487500 | NPI | - | NPPES |
| 7244008 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PS006504L (Pennsylvania) | Primary |
| Provider Name | Phyllis H Goltra |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467446625 PECOS PAC ID: 9830164573 Enrollment ID: I20040827000013 |
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