Provider Demographics
NPI:1427862804
Name:HUNTINGDON VALLEY PSYCHOTHERAPY
Entity type:Organization
Organization Name:HUNTINGDON VALLEY PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:PERSIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHIBILIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-312-2231
Mailing Address - Street 1:1067 HILLVIEW TURN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10125 VERREE RD STE 102
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3611
Practice Address - Country:US
Practice Address - Phone:267-312-2231
Practice Address - Fax:215-698-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health