Temple University of the Commonwealth System of Higher Education

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Doing business as

Temple Psychology Associates

Practice address

100 E Lehigh Ave BLDG Ste 105
Philadelphia, PA 19125-1012

Phone

(215) 707-8496

Fax

(215) 707-4086

NPI assigned

Oct 12, 2005

Organization subpart

No

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

Authorized official

Name

Tonya Woodard

Title

Credentialing/Manager

Phone

(215) 707-3911

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Temple Psychology Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1245228360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-8496",
            "fax_number": "215-707-4086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LEHIGH AVE BLDG STE 105",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191251012",
            "telephone_number": "215-707-8496",
            "fax_number": "215-707-4086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3509 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191404105",
            "country_code": "US",
            "telephone_number": "215-707-8496",
            "fax_number": "215-707-4086",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7600 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191112442",
            "country_code": "US",
            "telephone_number": "215-722-3258",
            "fax_number": "215-722-3863",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1316 W Ontario St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405220",
            "country_code": "US",
            "telephone_number": "215-707-8496",
            "fax_number": "215-707-4086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "CREDENTIALING/MANAGER",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130753",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130752",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130699",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Psychology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Temple Psychology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education
• Temple University of the Commonwealth System of Higher Education

• Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; 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.