Provider Demographics
NPI:1518056159
Name:WIVES SELF HELP FOUNDATION, INC
Entity type:Organization
Organization Name:WIVES SELF HELP FOUNDATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-332-1914
Mailing Address - Street 1:8001 ROOSEVELT BLVD
Mailing Address - Street 2:205-207
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3038
Mailing Address - Country:US
Mailing Address - Phone:215-332-1914
Mailing Address - Fax:215-332-1873
Practice Address - Street 1:8001 ROOSEVELT BLVD
Practice Address - Street 2:205-207
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-332-1914
Practice Address - Fax:215-332-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA130640101YM0800X, 103TA0700X, 103TB0200X, 103TC1900X, 103TC2200X, 104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWI428641OtherBC/BS ID 2
PA5356319OtherAETNA ID
PA0727023000OtherMAGELLAN ID
PA514223OtherBC/BS ID
PAWI514223Medicare ID - Type Unspecified