Provider Demographics
NPI:1821292053
Name:KIM MEREDITH
Entity Type:Organization
Organization Name:KIM MEREDITH
Other - Org Name:CHILDREN'S CRISIS TREATMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CLINICAL & QA
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTINGOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-496-9797
Mailing Address - Street 1:1823 CALLOWHILL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-4109
Mailing Address - Country:US
Mailing Address - Phone:212-496-0707
Mailing Address - Fax:215-496-0742
Practice Address - Street 1:1823 CALLOWHILL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-4109
Practice Address - Country:US
Practice Address - Phone:212-496-0707
Practice Address - Fax:215-496-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0143991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty