Organization
FORENSIC MENTAL HEALTH SERVICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM RUSSELL PH.D. (DIRECTOR)
(215) 514-1170
Entity
Organization
Contact information
Practice address
1241 VINE ST, PHILADELPHIA, PA 19107-1111
(215) 514-1170
(215) 405-2108
Mailing address
1241 VINE ST, PHILADELPHIA, PA 19107-1111
(215) 514-1170
(215) 405-2108
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
PA006981
PA
Other
Enumeration date
09/22/2014
Last updated
04/10/2015
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