Basic Information
| Provider Information | |||||||||
| NPI: | 1578690863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONGRESO DE LATINOS UNIDOS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 WEST SOMERSET STREET | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191333534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157638870 | ||||||||
| FaxNumber: | 2152919153 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 WEST SOMERSET STREET | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191333534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157638870 | ||||||||
| FaxNumber: | 2152919153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 08/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | PEREZ | ||||||||
| AuthorizedOfficialFirstName: | FELIX | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | QUALITY ASSURANCE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2157638870 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 850454 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 105810 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251S00000X | 85045A | PA | N | Agencies | Community/Behavioral Health | 251S00000X | 105810 | PA | Y | Agencies | Community/Behavioral Health |
No ID Information.