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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DANIEL LEE PSYD (CEO)
(215) 991-9066
Entity
Organization

Contact information

Practice address
6327 BURBRIDGE ST, PHILADELPHIA, PA 19144-2505
(215) 991-9066
(215) 991-9062
Mailing address
6327 BURBRIDGE ST, PHILADELPHIA, PA 19144-2505
(215) 991-9066
(215) 991-9062

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
101YP2500X
Professional Counselor
101YS0200X
School Counselor
103T00000X
Psychologist
103TC0700X
Clinical Psychologist
103TC2200X
Clinical Child & Adolescent Psychologist
PS016044
PA
103TP2701X
Group Psychotherapy Psychologist
104100000X
Social Worker
SW130970
PA
1041C0700X
Clinical Social Worker
1041S0200X
School Social Worker
SW130970
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PS016044
LICENSE
PA
Enumeration date
03/15/2016
Last updated
03/22/2016
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