Provider Demographics
NPI:1063718450
Name:MILTON H ERICKSON INSTITUTE OF PHILADELPHIA
Entity type:Organization
Organization Name:MILTON H ERICKSON INSTITUTE OF PHILADELPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-363-8717
Mailing Address - Street 1:660 EXTON CMNS
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2446
Mailing Address - Country:US
Mailing Address - Phone:610-363-8717
Mailing Address - Fax:610-430-8307
Practice Address - Street 1:660 EXTON CMNS
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2446
Practice Address - Country:US
Practice Address - Phone:610-363-8717
Practice Address - Fax:610-430-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty