NPIMap

Organization Active NPI

The Men's Resource Center

  • Clinical Social Worker
  • Philadelphia, PA
National Provider Identifier
1730292277
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CWO12294 Issued in PA
Legal business name
THE MEN'S RESOURCE CENTER
Practice address
1601 Walnut St
Suite 1017
Philadelphia, PA 19102-2944
Phone
(215) 564-0488
Fax
(215) 564-1245
NPI assigned
Aug 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Gerald Benjamin Evans, LCSWNPI 1235332743
Title
Director
Phone
(215) 564-0488

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 Worker 1041C0700X CWO12294 PA Primary

Addresses

Primary practice location

1601 Walnut St
Suite 1017
Philadelphia, PA 19102-2944

Mailing address

1601 Walnut St
Suite 1017
Philadelphia, PA 19102-2944
Phone (215) 564-0488

Other identifiers 1

IdentifierTypeStateIssuer
1012955860001MedicaidPA

National Provider Directory

National Provider Directory

Locations

1601 Walnut St
Ste 1017
Philadelphia, PA 19102
Phone (215) 564-0488

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730292277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 WALNUT ST",
            "address_2": "SUITE 1017",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022944",
            "telephone_number": "215-564-0488",
            "fax_number": "215-564-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 WALNUT ST",
            "address_2": "SUITE 1017",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022944",
            "telephone_number": "215-564-0488",
            "fax_number": "215-564-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MEN'S RESOURCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "215-564-0488",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CWO12294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012955860001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.