Provider Demographics
NPI:1245447655
Name:COUNCIL FOR RELATIONSHIPS
Entity type:Organization
Organization Name:COUNCIL FOR RELATIONSHIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR STAFF THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:215-382-6680
Mailing Address - Street 1:1094 TINKERHILL RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-7603
Mailing Address - Country:US
Mailing Address - Phone:610-935-7393
Mailing Address - Fax:
Practice Address - Street 1:4025 CHESTNUT ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3054
Practice Address - Country:US
Practice Address - Phone:215-382-6680
Practice Address - Fax:215-386-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMF000049OtherMFT LICENSE NUMBER
PA27093OtherAAMFT ID NUMBER