NPIMap

Organization Active NPI

Forensic Mental Health Service, LLC

  • Group Psychotherapy Psychologist
  • Philadelphia, PA
National Provider Identifier
1598167553
Registry record updated Apr 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
License
PA006981 Issued in PA
Legal business name
FORENSIC MENTAL HEALTH SERVICE, LLC
Practice address
1241 Vine St
Philadelphia, PA 19107-1111
Phone
(215) 514-1170
Fax
(215) 405-2108
NPI assigned
Sep 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2015

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

Authorized official

Name
Dr. William Russell, PH.D.
Title
Director
Phone
(215) 514-1170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X PA006981 PA Primary

Addresses

Primary practice location

1241 Vine St
Philadelphia, PA 19107-1111

Mailing address

1241 Vine St
Philadelphia, PA 19107-1111
Phone (215) 514-1170

National Provider Directory

National Provider Directory

Locations

1241 Vine St
Philadelphia, PA 19107
Phone (215) 514-1170

NPI Registry JSON

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428624000000",
    "number": "1598167553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 VINE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191071111",
            "telephone_number": "215-514-1170",
            "fax_number": "215-405-2108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 VINE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191071111",
            "telephone_number": "215-514-1170",
            "fax_number": "215-405-2108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORENSIC MENTAL HEALTH SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-22",
        "last_updated": "2015-04-10",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "215-514-1170",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "PA",
            "license": "PA006981",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 10, 2015; 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.