Organization
UNIVERSITY OF PENN PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(866) 301-4724
(215) 662-7200
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-7583
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
PA
104100000X
Social Worker
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007839500
—
PA
01
—
039240
BLUE SHIELD
PA
05
—
8749400
—
NJ
01
—
CA5037
RAILROAD MEDICARE
PA
Enumeration date
08/14/2006
Last updated
07/15/2010
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