Organization
WORDSWORTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA LACKS (PRESIDENT/CEO)
(215) 643-5400
Entity
Organization
Contact information
Practice address
3300 HENRY AVE, 2ND FLOOR, PHILADELPHIA, PA 19129-1121
(245) 643-5400
(267) 529-1942
Mailing address
3300 HENRY AVE, 2ND FLOOR, PHILADELPHIA, PA 19129-1121
(215) 643-5400
(267) 529-1942
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
100728361
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114060043
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
1295877314
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
1407806433
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
1477695542
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
1588008643
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
1669514774
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
1801203567
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
1841333770
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
1932242864
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
1942342878
COMMUNITY BEHAVIORAL HEALTH
PA
Enumeration date
01/12/2016
Last updated
01/12/2016
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