NPIMap

Organization Active NPI

Kim Meredith

  • Clinical Social Worker
  • Philadelphia, PA
National Provider Identifier
1821292053
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CW014399 Issued in PA
Legal business name
KIM MEREDITH
Practice address
1823 Callowhill St
Philadelphia, PA 19130-4109
Phone
(212) 496-0707
Fax
(215) 496-0742
NPI assigned
Jun 12, 2007
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
Dr. Andrea Ettingoff
Title
Director of Clinical & Qa
Phone
(215) 496-9797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X CW014399 PA Primary

Addresses

Primary practice location

1823 Callowhill St
Philadelphia, PA 19130-4109

Mailing address

1823 Callowhill St
Philadelphia, PA 19130-4109
Phone (212) 496-0707

Other names 1

  • Children's Crisis Treatment Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Children'S Crisis Treatment Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1823 Callowhill St
Philadelphia, PA 19130
Phone (212) 496-0707

Practitioners & affiliated clinicians

Practitioners 2

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": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821292053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1823 CALLOWHILL ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191304109",
            "telephone_number": "212-496-0707",
            "fax_number": "215-496-0742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1823 CALLOWHILL ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191304109",
            "telephone_number": "212-496-0707",
            "fax_number": "215-496-0742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM MEREDITH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ETTINGOFF",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL & QA",
        "authorized_official_telephone_number": "215-496-9797",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW014399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Crisis Treatment Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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.