Provider Demographics
NPI:1790015584
Name:MATERNAL CHILD CONSORTIUM, INC.
Entity Type:Organization
Organization Name:MATERNAL CHILD CONSORTIUM, INC.
Other - Org Name:MCC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWNELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:267-525-7000
Mailing Address - Street 1:800 CLARMONT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5705
Mailing Address - Country:US
Mailing Address - Phone:267-525-7000
Mailing Address - Fax:267-525-7010
Practice Address - Street 1:3400 HULMEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5705
Practice Address - Country:US
Practice Address - Phone:267-525-7000
Practice Address - Fax:267-525-7010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATERNAL CHILD CONSORTIUM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA112720251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007762890001Medicaid