Provider Demographics
NPI:1902565609
Name:CHILDREN'S CRISIS TREATMENT CENTER
Entity type:Organization
Organization Name:CHILDREN'S CRISIS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL AND QUALITY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ETTINGOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-496-0707
Mailing Address - Street 1:1080 N DELAWARE AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4339
Mailing Address - Country:US
Mailing Address - Phone:215-496-0707
Mailing Address - Fax:
Practice Address - Street 1:525 CLINTON ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1223
Practice Address - Country:US
Practice Address - Phone:215-496-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health