| Thomas Jefferson University | |
|
1021 South 21st Street Philadelphia PA 19146 | |
| (215) 735-5979 | |
| Not Available |
| Full Name | Thomas Jefferson University |
|---|---|
| Speciality | Public Health Or Welfare |
| Location | 1021 South 21st Street, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Robert Charles Sterling (DIRECTOR) |
| Authorized Official Contact | 2157909942 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas Jefferson University 1021 S 21st St Philadelphia PA 19146-2634 Ph: (215) 790-9942 | Thomas Jefferson University 1021 South 21st Street Philadelphia PA 19146 Ph: (215) 735-5979 |
| NPI Number | 1467547968 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 01/31/2020 |
| Certification Date | 01/31/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467547968 | NPI | - | NPPES |
| 1007571300083 | Other | PA | MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 251K00000X | Public Health Or Welfare | 820023 (Pennsylvania) | Primary |
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