Provider Demographics
NPI:1073086963
Name:EASTERSEALS OF SOUTHEASTERN PENNSYLVANIA
Entity Type:Organization
Organization Name:EASTERSEALS OF SOUTHEASTERN PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATABASE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARNEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-292-6012
Mailing Address - Street 1:3975 CONSHOHOCKEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-5426
Mailing Address - Country:US
Mailing Address - Phone:267-292-6012
Mailing Address - Fax:215-879-8424
Practice Address - Street 1:3975 CONSHOHOCKEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-5426
Practice Address - Country:US
Practice Address - Phone:267-292-6012
Practice Address - Fax:215-879-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health