DR. MICHAEL ANDREW WILLISTON (NPI# 1093090474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093090474 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL ANDREW WILLISTON |
| Other Name | MR. MICHAEL ANDREW HOLSTON |
| Credential | PSY.D. |
| Practice Address |
112 N Broad St Philadelphia PA 19102-1512 |
| Practice Telephone | 2155680860 |
| Mailing Telephone | 2155680860 |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | Behavioral Health & Social Service Providers |
| Street Address |
112 N BROAD ST |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19102-1512 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619088788 | John F. Kennedy Community Mh/mr Center | Social Worker | 112 N Broad St, Philadelphia, PA 19102-1510 | 2006-08-31 |
| 1851948848 | Annette Kennedy | Licensed Practical Nurse | 112 N Broad St, Philadelphia, PA 19102-1512 | 2019-08-23 |
| 1083261028 | Kelly Courtney | Case Manager/Care Coordinator | 112 N Broad St, Philadelphia, PA 19102-1512 | 2019-08-23 |
| 1093362097 | Doven Brezner | Counselor | 112 N Broad St, Philadelphia, PA 19102-1512 | 2019-08-23 |
| 1891342804 | Anna Jackson | Counselor | 112 N Broad St, Philadelphia, PA 19102-1512 | 2019-08-23 |
| 1881241867 | Jasmine Barnes | Case Manager/Care Coordinator | 112 N Broad St, Philadelphia, PA 19102-1512 | 2019-08-23 |
| 1366099343 | Emma Ledden | Counselor | 112 N Broad St, Philadelphia, PA 19102-1512 | 2019-08-23 |
| 1801443890 | Jasmine Richardson | Counselor | 112 N Broad St, Philadelphia, PA 19102-1512 | 2019-08-23 |
| 1831746833 | Sean Terence Smith | Counselor | 112 N Broad St, Philadelphia, PA 19102-1512 | 2019-08-23 |
| 1962059972 | Marybeth Goldberg | Counselor | 112 N Broad St, Philadelphia, PA 19102-1512 | 2019-08-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821650847 | Alexandre Mason Sharma | Student in an Organized Health Care Education/Training Program | 200 N 16th St Apt 1318, Philadelphia, PA 19102 | 2019-06-29 |
| 1720648223 | Ali Haydar | Internal Medicine | 245 N. 15th St, 6th Floor, Ms 42, Philadelphia, PA 19102 | 2019-06-17 |
| 1124688734 | Aakash Patel | Internal Medicine | Drexel University College of Medicine-internal Medicine, 245 N. 15th St. 6th Floor, Ms 427, Philadelphia, PA 19102 | 2019-06-17 |
| 1245898170 | Parth Javia | Internal Medicine | 245 N. 15th St., 6th Floor, Ms 427, Philadelphia, PA 19102 | 2019-06-05 |
| 1588120968 | John Granger II | Social Worker | 1500 Market St. 12th Floor Suite 75, Philadelphia, PA 19102 | 2019-02-11 |
| 1750851390 | Philadelphia Pain and Neurology Institute, LLC | Chiropractor | 1528 Walnut Street Suite 620, Philadelphia, PA 19102 | 2018-11-27 |
| 1770076465 | Sarthi Dalal | Internal Medicine | 245 N 15th St, Fl 6, Ms 427, Philadelphia, PA 19102 | 2018-06-07 |
| 1255824033 | Joyce Nimo-boampong | Internal Medicine | Drexel University College of Medicine, 245 N 15th St, 6th Floor,ms 427, Philadelphia, PA 19102 | 2018-06-07 |
| 1134625692 | Emma Rose Gormley | Social Worker | 1601 Walnut St Ste 1516, Philadelphia, PA 19102 | 2018-04-03 |
| 1851808497 | Sunish Shah | Pharmacist | 230 N Broad St, Philadelphia, Pa 19102, Philadelphia, PA 19102 | 2018-01-04 |
| Find all providers in zip 19102 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578937 | Margaret Edwards | Psychologist | 110 S 20th St Ste 206, Philadelphia, PA 19103-4486 | 2020-11-03 |
| 1699374843 | Elizabeth Ann Johnson | Psychologist | 3640 Stanton St Apt 107, Philadelphia, PA 19129-1683 | 2020-10-20 |
| 1689272577 | Katherine Piselli | Psychologist | 3401 Market St Ofc 3216, Philadelphia, PA 19104-3318 | 2020-10-13 |
| 1912518226 | Karen Dybner-madero | Psychologist | 2201 Pennsylvania Avenue, The Parkway House, Suite 101, Philadelphia, PA 19130 | 2020-08-11 |
| 1659980621 | Corinne Masur | Psychologist | 1601 Walnut St Ste 1408, Philadelphia, PA 19102-2909 | 2020-07-27 |
| 1730798067 | Amanda Marie Large | Psychologist | 1516 N 5th St Unit 401, Philadelphia, PA 19122-3679 | 2020-07-22 |
| 1295355543 | Jennifer Ann Engelhardt | Psychologist | 8201 Henry Ave Apt Q15, Philadelphia, PA 19128-2248 | 2020-04-16 |
| 1336778315 | Carly Mirit Gerbi | Psychologist | 2227 Delancey Pl, Philadelphia, PA 19103-6549 | 2020-04-02 |
| 1811530512 | Tower Drexel Academic Medical Group LLC | Psychologist | 1427 Vine St Fl 1, Philadelphia, PA 19102-1031 | 2019-10-25 |
| 1003459702 | Tower Drexel Academic Medical Group LLC | Psychologist | 4700 Wissahickon Ave Ste C102, Philadelphia, PA 19144-4248 | 2019-10-25 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19102 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.