1245447655 NPI number — COUNCIL FOR RELATIONSHIPS

Table of content: (NPI 1245447655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245447655 NPI number — COUNCIL FOR RELATIONSHIPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNCIL FOR RELATIONSHIPS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245447655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1094 TINKERHILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALVERN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19355-7603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-935-7393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4025 CHESTNUT ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-382-6680
Provider Business Practice Location Address Fax Number:
215-386-1743
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROTH
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SENIOR STAFF THERAPIST
Authorized Official Telephone Number:
215-382-6680

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MF000049 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MF000049 . This is a "MFT LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 27093 . This is a "AAMFT ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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