Provider Demographics
NPI:1841336880
Name:ST. REGIS PSYCHOLOGICAL & EDUCATIONAL ASSOC.LTD
Entity type:Organization
Organization Name:ST. REGIS PSYCHOLOGICAL & EDUCATIONAL ASSOC.LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GIOE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-923-5803
Mailing Address - Street 1:822 PINE ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6187
Mailing Address - Country:US
Mailing Address - Phone:215-923-5803
Mailing Address - Fax:215-923-5758
Practice Address - Street 1:822 PINE ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6187
Practice Address - Country:US
Practice Address - Phone:215-923-5803
Practice Address - Fax:215-923-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002386-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2907367OtherAETNA
PA0063161000OtherBLUE SHIELD
PAST 888479OtherBLUE SHIELD