Healthcare Provider Details

I. General information

NPI: 1316020910
Provider Name (Legal Business Name): CHILD GUIDANCE RESOURCE CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

V. Phone/Fax

Practice location:
  • Phone: 484-454-8700
  • Fax: 454-454-8706
Mailing address:
  • Phone: 484-454-8700
  • Fax: 454-454-8706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number112610
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number112610
License Number StatePA

VIII. Authorized Official

Name: MS. AMY MEADOWS-MARTELLA
Title or Position: VP, OPERATIONS
Credential: MFT
Phone: 484-454-8700