| Citywide Community Counseling Service Inc | |
|
537 E Allegheny Ave Philadelphia PA 19134-2328 | |
| (215) 291-9500 | |
| Not Available |
| Full Name | Citywide Community Counseling Service Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 537 E Allegheny Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Claudio Roman (CEO/PRESIDENT) |
| Authorized Official Contact | 2152919500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Citywide Community Counseling Service Inc 537 E Allegheny Ave Philadelphia PA 19134-2328 Ph: (215) 291-9500 | Citywide Community Counseling Service Inc 537 E Allegheny Ave Philadelphia PA 19134-2328 Ph: (215) 291-9500 |
| NPI Number | 1558553271 |
|---|---|
| Provider Enumeration Date | 08/16/2007 |
| Last Update Date | 04/14/2023 |
| Certification Date | 04/14/2023 |
| Medicare PECOS PAC ID | 3476928979 |
|---|---|
| Medicare Enrollment ID | O20230415000029 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558553271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 129420 (Pennsylvania) | Primary |
| Provider Name | Orlando Matiz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104943802 PECOS PAC ID: 3779748959 Enrollment ID: I20120713000520 |
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