Provider Demographics
NPI:1962758052
Name:FRANK, JEREMY PHILIP (PHD CAC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:PHILIP
Last Name:FRANK
Suffix:
Gender:M
Credentials:PHD CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 CITY AVE STE D108
Mailing Address - Street 2:PRESIDENTIAL CITY APARTMENTS, MADISON BLDG.
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2926
Mailing Address - Country:US
Mailing Address - Phone:215-356-8061
Mailing Address - Fax:
Practice Address - Street 1:3900 CITY AVE STE D108
Practice Address - Street 2:PRESIDENTIAL CITY APARTMENTS, MADISON BLDG.
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131-2926
Practice Address - Country:US
Practice Address - Phone:215-356-8061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015328103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)