NPIMap

Organization Active NPI

Philadelphia Concussion Specialists

  • Clinical Psychologist
  • Drexel Hill, PA
National Provider Identifier
1831732007
Registry record updated Feb 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
PHILADELPHIA CONCUSSION SPECIALISTS
Practice address
3300 Township Line Rd
Drexel Hill, PA 19026-1925
Phone
(484) 818-2225
Fax
(866) 818-4032
NPI assigned
Oct 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2020

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

Authorized official

Name
Stephen A Russo, PHD
Title
Founder & Clinical Director
Phone
(484) 818-2225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

3300 Township Line Rd
Drexel Hill, PA 19026-1925

Mailing address

PO Box 741
Media, PA 19063-0741
Phone (484) 818-2225

National Provider Directory

National Provider Directory

Locations

3300 Township Line Rd
Drexel Hill, PA 19026
Phone (484) 818-2225

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1571616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581120000000",
    "number": "1831732007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190630741",
            "telephone_number": "484-818-2225",
            "fax_number": "866-818-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 TOWNSHIP LINE RD",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190261925",
            "telephone_number": "484-818-2225",
            "fax_number": "866-818-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA CONCUSSION SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-21",
        "last_updated": "2020-02-08",
        "certification_date": "2020-02-08",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "FOUNDER & CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "484-818-2225",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Drexel Hill, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.