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General NPI Number Information
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NPI Number | 1104353994
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Entity Type | Organization
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Legal Business Name | SYMMETRY TRANSITION SERVICES
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 1436 S 2ND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-6104
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Country | US
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Telephone | 215-370-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 2208 S 3RD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3301
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Country | US
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Telephone | 215-605-3998
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Fax |
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Authorized Official
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Title or Position | VP OF CLINICAL SERVICES
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Name | MS. KIMBERLY ANN PAKECH
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Credential | LCSW, LCADC
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Telephone | 215-370-4325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CW017139
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CW017139
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CW017139
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CW017139
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | CW017139
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW017139
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License Number State | PA
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Taxonomy #7
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | CW017139
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License Number State | PA
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