Provider Demographics
NPI:1568418721
Name:GKSW CRYSTAL GROUP ASSOCIATES
Entity Type:Organization
Organization Name:GKSW CRYSTAL GROUP ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYJEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-233-3994
Mailing Address - Street 1:8200 FLOURTOWN AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7976
Mailing Address - Country:US
Mailing Address - Phone:215-233-3994
Mailing Address - Fax:215-233-3997
Practice Address - Street 1:8200 FLOURTOWN AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7976
Practice Address - Country:US
Practice Address - Phone:215-233-3994
Practice Address - Fax:215-233-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA630230Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER