Provider Demographics
NPI:1912030057
Name:SELF EXPRESSIONS
Entity Type:Organization
Organization Name:SELF EXPRESSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LSW
Authorized Official - Phone:610-251-0821
Mailing Address - Street 1:SWEDESFORD CORPORATE CENTER
Mailing Address - Street 2:617 B. SWEDESFORD ROAD
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355
Mailing Address - Country:US
Mailing Address - Phone:610-251-0821
Mailing Address - Fax:610-251-0822
Practice Address - Street 1:SWEDESFORD CORPORATE CENTER
Practice Address - Street 2:617 B. SWEDESFORD ROAD
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355
Practice Address - Country:US
Practice Address - Phone:610-251-0821
Practice Address - Fax:610-251-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW006701L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty