Provider Demographics
NPI:1710577499
Name:COMMON GROUND RELATIONSHIP THERAPY, LLC
Entity Type:Organization
Organization Name:COMMON GROUND RELATIONSHIP THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCIERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:856-905-0032
Mailing Address - Street 1:31 ALEXANDER CT
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2115
Mailing Address - Country:US
Mailing Address - Phone:856-905-0032
Mailing Address - Fax:
Practice Address - Street 1:300 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9556
Practice Address - Country:US
Practice Address - Phone:856-905-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty