Healthcare Provider Details

I. General information

NPI: 1568418721
Provider Name (Legal Business Name): GKSW CRYSTAL GROUP ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 FLOURTOWN AVE SUITE 8
WYNDMOOR PA
19038-7976
US

IV. Provider business mailing address

8200 FLOURTOWN AVE SUITE 8
WYNDMOOR PA
19038-7976
US

V. Phone/Fax

Practice location:
  • Phone: 215-233-3994
  • Fax: 215-233-3997
Mailing address:
  • Phone: 215-233-3994
  • Fax: 215-233-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARYJEAN O'BYRNE
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-233-3994