Organization
WILLOW MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN C LEVINE LSW (OWNER/FOUNDER)
(617) 750-8311
Entity
Organization
Contact information
Practice address
1912 FERNON ST, PHILADELPHIA, PA 19145-1420
(617) 750-8311
Mailing address
1912 FERNON ST, PHILADELPHIA, PA 19145-1420
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/17/2025
Last updated
02/17/2025
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