1881918472 NPI number — AVERSA COUNSELING GROUP OF CHESTER COUNTY

Table of content: DR. QING TAI M.D., PH.D. (NPI 1093750069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881918472 NPI number — AVERSA COUNSELING GROUP OF CHESTER COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVERSA COUNSELING GROUP OF CHESTER COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881918472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
238 ICEDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONEY BROOK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19344-8661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-842-6153
Provider Business Mailing Address Fax Number:
610-363-7116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
238 ICEDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONEY BROOK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19344-8661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-842-6153
Provider Business Practice Location Address Fax Number:
610-942-2768
Provider Enumeration Date:
03/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AVERSA
Authorized Official First Name:
JEANINE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DIRECTOR /THERAPIST
Authorized Official Telephone Number:
610-363-7115

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC004812 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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