Provider Demographics
NPI:1891856407
Name:SWARTHMORE ASSOCIATES
Entity Type:Organization
Organization Name:SWARTHMORE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-328-6768
Mailing Address - Street 1:613 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1132
Mailing Address - Country:US
Mailing Address - Phone:610-328-6768
Mailing Address - Fax:610-328-6768
Practice Address - Street 1:613 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1132
Practice Address - Country:US
Practice Address - Phone:610-328-6768
Practice Address - Fax:610-328-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004152L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA890172Medicare ID - Type Unspecified