Provider Demographics
NPI:1861048126
Name:ALLY PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:ALLY PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:ASSOIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:267-432-9103
Mailing Address - Street 1:512 ANTHEM WAY
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-1931
Mailing Address - Country:US
Mailing Address - Phone:201-693-5608
Mailing Address - Fax:
Practice Address - Street 1:5049 SWAMP RD STE 303
Practice Address - Street 2:
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923-9660
Practice Address - Country:US
Practice Address - Phone:267-432-9103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty