Provider Demographics
NPI:1386910149
Name:CENTER FOR LOSS AND BEREAVEMENT
Entity type:Organization
Organization Name:CENTER FOR LOSS AND BEREAVEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:610-222-4110
Mailing Address - Street 1:3847 SKIPPACK PIKE
Mailing Address - Street 2:
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474-1299
Mailing Address - Country:US
Mailing Address - Phone:610-222-4110
Mailing Address - Fax:
Practice Address - Street 1:3847 SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474-1299
Practice Address - Country:US
Practice Address - Phone:610-222-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000192251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable