Estadt Psychological Services, LLC
Organization Active NPI Clinical Psychologist · Philadelphia, PA
NPI 1801288667 · NPPES record last updated Mar 3, 2015
Key facts
- NPI
- 1801288667
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- Legal business name
- ESTADT PSYCHOLOGICAL SERVICES, LLC
- Practice address
- 1930 S Broad St
Philadelphia, PA 19145-2328 - Phone
- (267) 304-3414
- NPI assigned
- Mar 3, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Gregory John Estadt, PSY.D.
- Title
- Owner
- Phone
- (267) 304-3414
Practitioners 12
-
Craig Marshall Aaron, LMFT
-
Beau Charles Brendley, PSY D
-
Sonya Lynn Chartoff, LPC
-
Gregory John Estadt, PSY.D.
-
Gerlinde Christa Harb, PH.D.
-
Evan Batts Morrow, LCSW
-
Janine Oliver, LCSW
-
Maureen Townsend, LCSW
-
Ahyoung Tae, PSYD
-
Yael Taler, PSYD
-
Karolina Lazarov, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150619000370 | PA | Part B Supplier - Clinic/Group Practice | 6800107640 |
Receives reassigned benefits from 11 practitioners Practice locations: Media, PA; Philadelphia, PA |
National Provider Directory
Locations
2201 Pine St
Fl 2
Philadelphia, PA 19103
Phone (267) 304-3414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | Yes |
Addresses
Primary practice location
1930 S Broad St
Philadelphia, PA 19145-2328
Mailing address
2926 S 15TH St
Philadelphia, PA 19145-4917
Phone (267) 304-3414
Other providers in Philadelphia, PA
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- Dinah Essilfie
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- Nora V Esteban-Cruciani
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All providers in Philadelphia, PA · Clinical Psychologist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.