Organization
NORTHEAST COMMUNITY CENTER FOR MENTAL HEALTH & MENTAL RETARDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD J KAUFMAN (EXECUTIVE DIRECTOR)
(215) 831-2800
Entity
Organization
Contact information
Practice address
7226 CASTOR AVE, PHILADELPHIA, PA 19149-1108
(215) 742-7820
(215) 742-7808
Mailing address
4641 ROOSEVELT BLVD, PHILADELPHIA, PA 19124-2343
(215) 831-2800
(215) 831-2929
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
188220
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000034170058
—
PA
Enumeration date
01/08/2007
Last updated
08/22/2020
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