Healthcare Provider Details

I. General information

NPI: 1306111091
Provider Name (Legal Business Name): CLEAR FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 BRISTOL PIKE ONE WOODHAVEN SUITE 205
BENSALEM PA
19020-5679
US

IV. Provider business mailing address

21 ORIOLE WAY
MOORESTOWN NJ
08057-1335
US

V. Phone/Fax

Practice location:
  • Phone: 484-472-7430
  • Fax: 484-472-7718
Mailing address:
  • Phone: 484-472-7430
  • Fax: 484-472-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. PAMELA J RALPH
Title or Position: DIRECTOR
Credential: M.D.
Phone: 484-472-7430