Provider Demographics
NPI:1306926829
Name:JENKINTOWN PSYCHOLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:JENKINTOWN PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MONTANARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-885-1252
Mailing Address - Street 1:601 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3238
Mailing Address - Country:US
Mailing Address - Phone:215-885-1252
Mailing Address - Fax:215-885-1310
Practice Address - Street 1:601 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3238
Practice Address - Country:US
Practice Address - Phone:215-885-1252
Practice Address - Fax:215-885-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005303-L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty