Philadelphia Concussion Specialists
Psychologist, Clinical in Drexel Hill, PA. Organization (NPI-2).
NPI number1831732007
StatusActive
Last updated in NPPESFeb 8, 2020
Details
- NPI
- 1831732007
- Entity type
- Organization (NPI-2)
- Legal business name
- Philadelphia Concussion Specialists
- Organization subpart
- No
- Enumeration date
- Oct 21, 2019
- Certification date
- Feb 8, 2020
- Last updated
- Feb 8, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | – | – | Yes |
Practice location
3300 Township Line RdDrexel Hill, PA 19026-1925
Phone 484-818-2225 · Fax 866-818-4032
Mailing address
Po Box 741Media, PA 19063-0741
Phone 484-818-2225 · Fax 866-818-4032
Authorized official
Stephen A Russo
Founder & Clinical Director
4848182225
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