MEDICARE: CITIZEN'S ACTING TOGETHER CAN HELP, INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	191020	PA
2	101YM0800X	Mental Health Counselor	123980	PA
3	101YM0800X	Mental Health Counselor	187880	PA
4	103T00000X	Psychologist	191020	PA
5	104100000X	Social Worker	191020	PA
6	106H00000X	Marriage & Family Therapist	191020	PA
7	251B00000X	Case Management Agency		PA
8	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	191020	PA
9	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	123980	PA
10	261QM0850X	Adult Mental Health Clinic/Center	123980	PA
11	261QM0850X	Adult Mental Health Clinic/Center	191020	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1396715009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITIZEN'S ACTING TOGETHER CAN HELP, INC.

Provider Business Mailing Address
First Line	:	1409 LOMBARD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1656
Country	:	US
Telephone Number	:	215-875-2187
Fax Number	:	215-545-0828

Provider Business Practice Location Address
First Line	:	1400 REED ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4823
Country	:	US
Telephone Number	:	215-755-0500
Fax Number	:	215-755-3561

Authorized Official
Title or Position	:	CFO
Name	:	MR. JAMES KENNEDY
Credential	:
Telephone Number	:	215-875-2183

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	12/16/2008