Provider Demographics
NPI:1568682805
Name:GENETIC & DEVELOPMENTAL CENTER OF SW,PA
Entity Type:Organization
Organization Name:GENETIC & DEVELOPMENTAL CENTER OF SW,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:CARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-277-6400
Mailing Address - Street 1:801 E BORDER ST
Mailing Address - Street 2:L.
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7494
Mailing Address - Country:US
Mailing Address - Phone:817-277-6400
Mailing Address - Fax:817-277-6414
Practice Address - Street 1:801 E BORDER ST
Practice Address - Street 2:L.
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-7494
Practice Address - Country:US
Practice Address - Phone:817-277-6400
Practice Address - Fax:817-277-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2521170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty