NPIMap

Organization Active NPI

Jewish Family Psych Serv

  • Clinical Psychologist
  • Philadelphia, PA
National Provider Identifier
1679606974
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
JEWISH FAMILY PSYCH SERV
Practice address
2100 Arch St
5TH FL
Philadelphia, PA 19103-1300
Phone
(215) 496-9700
Fax
(215) 496-6622
NPI assigned
Mar 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Susan Wyland
Title
Cfo
Phone
(215) 496-9700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PA Primary

Addresses

Primary practice location

2100 Arch St
5TH FL
Philadelphia, PA 19103-1300

Mailing address

2100 Arch St
5TH FL
Philadelphia, PA 19103-1300
Phone (215) 496-9700

Other identifiers 2

IdentifierTypeStateIssuer
1000008810009MedicaidPA
1000008810025OtherPAWELFARE MEDICAID

National Provider Directory

National Provider Directory

Locations

10125 Verree Rd
Ste 300
Philadelphia, PA 19116
Phone (215) 673-0100

2100 Arch St
Philadelphia, PA 19103
Phone (215) 496-9700

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": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679606974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 ARCH ST",
            "address_2": "5TH FL",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191031300",
            "telephone_number": "215-496-9700",
            "fax_number": "215-496-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 ARCH ST",
            "address_2": "5TH FL",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191031300",
            "telephone_number": "215-496-9700",
            "fax_number": "215-496-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWISH FAMILY PSYCH SERV",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WYLAND",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "215-496-9700"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000008810009",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELFARE MEDICAID",
            "identifier": "1000008810025",
            "state": "PA"
        }
    ],
    "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 Aug 22, 2020; 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.