NPIMap

Organization Active NPI

Fairless Hills Psychological Associates

  • Group Psychotherapy Psychologist
  • Fairless Hills, PA
National Provider Identifier
1073684254
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
License
000256L Issued in PA
Legal business name
FAIRLESS HILLS PSYCHOLOGICAL ASSOCIATES
Practice address
333 N Oxford Valley Rd
Suite 202
Fairless Hills, PA 19030-2624
Phone
(215) 547-5774
Fax
(215) 547-0768
NPI assigned
Nov 10, 2006
Last updated
Apr 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Daniel Rosella Sr., PH.D.NPI 1770548653
Title
Clinical Psychologist
Phone
(215) 547-5774

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Group Psychotherapy Psychologist 103TP2701X 000256L PA Primary

Addresses

Primary practice location

333 N Oxford Valley Rd
Suite 202
Fairless Hills, PA 19030-2624

Mailing address

333 N Oxford Valley Rd
Suite 202
Fairless Hills, PA 19030-2624
Phone (215) 547-5774

Other identifiers 1

IdentifierTypeStateIssuer
127353001MedicaidPA

Other names 1

  • Fairless Hills Psychological Associates Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623001303 PA Part B Supplier - Clinic/Group Practice 9133104029 Receives reassigned benefits from 2 practitioners
Practice locations: Newtown, PA

National Provider Directory

National Provider Directory
Tax ID family
Fairless Hills Psychological2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1073684254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N OXFORD VALLEY RD",
            "address_2": "SUITE 202",
            "city": "FAIRLESS HILLS",
            "state": "PA",
            "postal_code": "190302624",
            "telephone_number": "215-547-5774",
            "fax_number": "215-547-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N OXFORD VALLEY RD",
            "address_2": "SUITE 202",
            "city": "FAIRLESS HILLS",
            "state": "PA",
            "postal_code": "190302624",
            "telephone_number": "215-547-5774",
            "fax_number": "215-547-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRLESS HILLS PSYCHOLOGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "ROSELLA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "215-547-5774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "PA",
            "license": "000256L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127353001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairless Hills Psychological Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fairless Hills, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.