MEDICARE: GKSW CRYSTAL GROUP ASSOCIATES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1568418721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GKSW CRYSTAL GROUP ASSOCIATES

Provider Business Mailing Address
First Line	:	8200 FLOURTOWN AVE STE 8
Second Line	:
City	:	WYNDMOOR
State	:	PA
Zip	:	19038-7969
Country	:	US
Telephone Number	:	215-233-3994
Fax Number	:	215-233-3997

Provider Business Practice Location Address
First Line	:	8200 FLOURTOWN AVE
Second Line	:	SUITE 8
City	:	WYNDMOOR
State	:	PA
Zip	:	19038-7976
Country	:	US
Telephone Number	:	215-233-3994
Fax Number	:	215-233-3997

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARYJEAN O'BYRNE
Credential	:
Telephone Number	:	215-233-3994

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	04/09/2026

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