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General NPI Number Information
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NPI Number | 1316020910
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Entity Type | Organization
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Legal Business Name | CHILD GUIDANCE RESOURCE CENTERS INC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 2000 OLD WEST CHESTER PIKE
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City | HAVERTOWN
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State | PA
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Zip | 19083-2712
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Country | US
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Telephone | 484-454-8700
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Fax | 454-454-8706
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Provider Business Mailing Address
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Address Line | 2000 OLD WEST CHESTER PIKE
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City | HAVERTOWN
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State | PA
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Zip | 19083-2712
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Country | US
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Telephone | 484-454-8700
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Fax | 454-454-8706
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Authorized Official
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Title or Position | VP, OPERATIONS
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Name | MS. AMY MEADOWS-MARTELLA
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Credential | MFT
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Telephone | 484-454-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 112610
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 112610
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License Number State | PA
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