MEDICARE: CHILDREN'S CRISIS TREATMENT CENTER

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	251S00000X	Community/Behavioral Health Agency	PC004151	PA

General Provider Information

NPI Number	:	1992901714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S CRISIS TREATMENT CENTER

Provider Business Mailing Address
First Line	:	417 N 8TH ST
Second Line	:	SUITE 402
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3916
Country	:	US
Telephone Number	:	215-496-0707
Fax Number	:	215-627-9042

Provider Business Practice Location Address
First Line	:	417 N 8TH ST
Second Line	:	SUITE 402
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3916
Country	:	US
Telephone Number	:	215-496-0707
Fax Number	:	215-627-9042

Authorized Official
Title or Position	:	CLINICIAN
Name	:	SUSAN M STIMMELL
Credential	:
Telephone Number	:	215-496-0707

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	08/22/2020

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