NPIMap

Organization Active NPI

Conshohocken Center for Emotional Health

  • Clinical Social Worker
  • Conshohocken, PA
National Provider Identifier
1003363615
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CONSHOHOCKEN CENTER FOR EMOTIONAL HEALTH
Practice address
20 E 2ND Ave Ste 100
Conshohocken, PA 19428-1880
Phone
(610) 635-5677
Fax
(610) 828-4910
NPI assigned
Sep 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carolyn M Fortenberry, LCSWNPI 1215286273
Title
Business Owner
Phone
(610) 635-5677

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

20 E 2ND Ave Ste 100
Conshohocken, PA 19428-1880

Mailing address

1101 New Dehaven St
Conshohocken, PA 19428-2742
Phone (610) 635-5677

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161109000121 PA Part B Supplier - Clinic/Group Practice 0446539738 Receives reassigned benefits from 4 practitioners
Practice locations: Conshohocken, PA

National Provider Directory

National Provider Directory

Locations

20 E 2nd Ave
Ste 100
Conshohocken, PA 19428
Phone (484) 534-9686

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1003363615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 NEW DEHAVEN ST",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194282742",
            "telephone_number": "610-635-5677",
            "fax_number": "610-828-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E 2ND AVE STE 100",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194281880",
            "telephone_number": "610-635-5677",
            "fax_number": "610-828-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONSHOHOCKEN CENTER FOR EMOTIONAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A",
        "authorized_official_last_name": "FORTENBERRY",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "610-635-5677",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conshohocken, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.