MEDICARE: GERMANTOWN SETTLEMENT OUTPATIENT WELLNESS COUNSELING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	128600	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1020876680001	OTHER	PA	DPW PROVIDER NUMBER

General Provider Information

NPI Number	:	1255590469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERMANTOWN SETTLEMENT OUTPATIENT WELLNESS COUNSELING CENTER

Provider Business Mailing Address
First Line	:	208 W CHELTEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3803
Country	:	US
Telephone Number	:	215-849-3104
Fax Number	:	215-843-2618

Provider Business Practice Location Address
First Line	:	208 W CHELTEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3803
Country	:	US
Telephone Number	:	215-849-3104
Fax Number	:	215-843-2618

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. EMMA CUMMINGS-FREEMAN
Credential	:
Telephone Number	:	215-849-3104

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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