Healthcare Provider Details

I. General information

NPI: 1780269431
Provider Name (Legal Business Name): RECOVERED AND RESTORED EATING DISORDER THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 N BETHLEHEM PIKE STE AF
AMBLER PA
19002-2109
US

IV. Provider business mailing address

1018 N BETHLEHEM PIKE STE AF
AMBLER PA
19002-2109
US

V. Phone/Fax

Practice location:
  • Phone: 215-206-1749
  • Fax:
Mailing address:
  • Phone: 215-206-1749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE A MORREALE
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 215-206-1749