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General NPI Number Information
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NPI Number | 1780933481
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Entity Type | Individual
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Provider Name | CHARLES E GROVE PHD, MSW
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Gender | Male
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 01/02/2017
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Provider Practice Location Address
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Address Line | 1900 S ISEMINGER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2207
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Country | US
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Telephone | 267-847-4148
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Fax |
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Provider Business Mailing Address
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Address Line | 809 LOCUST ST MAZZONI CENTER FAMILY & COMMUNITY MEDICINE
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5507
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Country | US
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Telephone | 215-563-0658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 131589
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License Number State | PA
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