Provider Demographics
NPI:1841490877
Name:CLINICALRESOURCEGROUP,INC.
Entity type:Organization
Organization Name:CLINICALRESOURCEGROUP,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-853-9431
Mailing Address - Street 1:8703 WEST CHESTER PIKE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082
Mailing Address - Country:US
Mailing Address - Phone:610-853-9431
Mailing Address - Fax:610-853-9431
Practice Address - Street 1:8703 W CHESTER PIKE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1115
Practice Address - Country:US
Practice Address - Phone:610-853-9431
Practice Address - Fax:610-853-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACWO12105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty