Organization
COMMUNITY INTEGRATED SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN SCHONFELD (EXECUTIVE DIRECTOR)
(215) 870-7667
Entity
Organization
Contact information
Practice address
441 N 5TH ST STE 101, PHILADELPHIA, PA 19123-4009
(215) 870-7667
(215) 238-7423
Mailing address
441 N 5TH ST STE 101, PHILADELPHIA, PA 19123-4009
(215) 870-7667
(215) 238-7423
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
103TR0400X
Rehabilitation Psychologist
—
—
225CX0006X
Orientation and Mobility Training Rehabilitation Counselor
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000057
—
DE
05
—
000000060
—
DE
05
—
250604976
—
DE
Enumeration date
10/23/2020
Last updated
03/12/2021
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