39D2032451 CLIA NUMBER - COMMUNITY WOMEN'S CENTER OF PHILADELPHIA

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Laboratory Demographics

CLIA Number: 39D2032451

Facility Name: COMMUNITY WOMEN'S CENTER OF PHILADELPHIA

Facility Address:
1202 LOCUST ST 3RD FLOOR
PHILADELPHIA, PA
ZIP 19107
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Facility Phone Number: 215 826-8090

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1831314467

Taxonomy: 101Y00000X - Counselor
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

CLIA Record

Field Name	Field Value
CLIA Number	39D2032451
LAB Type	Community Clinic
Facility Name	COMMUNITY WOMEN'S CENTER OF PHILADELPHIA
Street	1202 LOCUST ST 3RD FLOOR
City	PHILADELPHIA
State	PA
ZIP	19107
Phone	215 826-8090
CertificateType	4
CertificateEffectiveDate	11/9/2023
CertificateExpirationDate	11/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024