Basic Information
| Provider Information | |||||||||
| NPI: | 1336289800 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORENSIC FAMILY THERAPY TREATMENT PROGRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 S BROAD STREET | ||||||||
| Address2: | 18TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159852500 | ||||||||
| FaxNumber: | 2157312049 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 CALLOWHILL ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191233604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154130141 | ||||||||
| FaxNumber: | 2154130144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 07/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | COHEN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2159852501 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.