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General NPI Number Information
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NPI Number | 1821292053
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Entity Type | Organization
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Legal Business Name | KIM MEREDITH
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1823 CALLOWHILL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-4109
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Country | US
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Telephone | 212-496-0707
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Fax | 215-496-0742
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Provider Business Mailing Address
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Address Line | 1823 CALLOWHILL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-4109
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Country | US
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Telephone | 212-496-0707
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Fax | 215-496-0742
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL & QA
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Name | DR. ANDREA ETTINGOFF
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Credential |
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Telephone | 215-496-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW014399
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License Number State | PA
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