Individual
DR. JACOB FIRESTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
3900 WOODLAND AVE, PHILADELPHIA, PA 19104-4551
(215) 823-5800
Mailing address
3900 WOODLAND AVE, PHILADELPHIA, PA 19104-4551
(215) 823-5800
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
022858
NY
103TC0700X
Clinical Psychologist
022858
NY
103TC0700X
Clinical Psychologist
Primary
022858
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103TC0700X
VA TAXONOMY
PA
Enumeration date
02/07/2019
Last updated
09/14/2020
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