Provider Demographics
NPI:1003363615
Name:CONSHOHOCKEN CENTER FOR EMOTIONAL HEALTH
Entity Type:Organization
Organization Name:CONSHOHOCKEN CENTER FOR EMOTIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-635-5677
Mailing Address - Street 1:20 E 2ND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1880
Mailing Address - Country:US
Mailing Address - Phone:610-635-5677
Mailing Address - Fax:610-828-4910
Practice Address - Street 1:20 E 2ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1880
Practice Address - Country:US
Practice Address - Phone:610-635-5677
Practice Address - Fax:610-828-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty