Active NPI
Jeanette Anne Pailas, M.A./A.T.R.-L.P.C.
- Professional Counselor
- Phila, PA
National Provider Identifier
1598090136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC004973
- Practice address
- 4641 Roosevelt Blvd
Phila, PA 19124-2343 - Phone
- (215) 831-2634
- NPI assigned
- Oct 15, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC004973 | PA | Primary |
Addresses
Primary practice location
4641 Roosevelt Blvd
Phila, PA 19124-2343
Mailing address
6706 Lincoln Dr
Phila, PA 19119-3155
Phone (215) 300-6170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC004973 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255564800000",
"number": "1598090136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6706 LINCOLN DR",
"city": "PHILA",
"state": "PA",
"postal_code": "191193155",
"telephone_number": "215-300-6170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4641 ROOSEVELT BLVD",
"city": "PHILA",
"state": "PA",
"postal_code": "191242343",
"telephone_number": "215-831-2634"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAILAS",
"first_name": "JEANETTE",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "M.A./A.T.R.-L.P.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-15",
"last_updated": "2009-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC004973",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phila, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.