Organization
TRANSITION PHASE III
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JO BENAIT PSYD (CEO GROUP ADMINISTRATOR)
(215) 878-3052
Entity
Organization
Contact information
Practice address
3900 CITY AVE, MADISON BLDG SUITE 1207, PHILADELPHIA, PA 19131-2908
(215) 878-3052
(215) 878-3532
Mailing address
3900 CITY AVENUE, MADISON BLDG SUITE 1207, PHILADELPHIA, PA 19131-0000
(215) 878-3052
(215) 878-3532
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019569460001
—
PA
Enumeration date
07/25/2007
Last updated
04/13/2010
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