1306977491 NPI number — PRIMAVERA PSYCHOLOGY ASSOCIATES, P.C.

Table of content: (NPI 1306977491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306977491 NPI number — PRIMAVERA PSYCHOLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMAVERA PSYCHOLOGY ASSOCIATES, P.C.
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:
1306977491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 CHESTNUT ST
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-4316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-625-9770
Provider Business Mailing Address Fax Number:
215-625-9866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-625-9770
Provider Business Practice Location Address Fax Number:
215-625-9866
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRIMAVERA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-625-9770

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS004716L , 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)

  • Identifier: 0247316000 . This is a "MHS NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7306218 . This is a "PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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