NPIMap

Organization Active NPI

Community Integrated Services

  • Intellectual & Developmental Disabilities Psychologist
  • Philadelphia, PA
National Provider Identifier
1235738824
Registry record updated Mar 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X
Legal business name
COMMUNITY INTEGRATED SERVICES
Practice address
441 N 5TH St Ste 101
Philadelphia, PA 19123-4009
Phone
(215) 870-7667
Fax
(215) 238-7423
NPI assigned
Oct 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2021

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

Authorized official

Name
Susan Schonfeld
Title
Executive Director
Phone
(215) 870-7667

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual & Developmental Disabilities PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TM1800X Primary
Rehabilitation PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TR0400X
Orientation and Mobility Training Rehabilitation CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 225CX0006X
Developmentally Disabled Services Day Training Agency 251C00000X
In Home Supportive Care Agency 253Z00000X

Addresses

Primary practice location

441 N 5TH St Ste 101
Philadelphia, PA 19123-4009

Mailing address

441 N 5TH St Ste 101
Philadelphia, PA 19123-4009
Phone (215) 870-7667

Other identifiers 3

IdentifierTypeStateIssuer
250604976MedicaidDE
000000060MedicaidDE
000000057MedicaidDE

National Provider Directory

National Provider Directory

Locations

441 N 5th St
Ste 101
Philadelphia, PA 19123
Phone (215) 870-7667

NPI Registry JSON

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

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615507200000",
    "number": "1235738824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 N 5TH ST STE 101",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191234009",
            "telephone_number": "215-870-7667",
            "fax_number": "215-238-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 N 5TH ST STE 101",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191234009",
            "telephone_number": "215-870-7667",
            "fax_number": "215-238-7423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY INTEGRATED SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-23",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A",
        "authorized_official_last_name": "SCHONFELD",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "215-870-7667"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225CX0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Rehabilitation Counselor, Orientation and Mobility Training Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250604976",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000060",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000057",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.