Provider Demographics
NPI:1780269431
Name:RECOVERED AND RESTORED EATING DISORDER THERAPY CENTER
Entity type:Organization
Organization Name:RECOVERED AND RESTORED EATING DISORDER THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:215-206-1749
Mailing Address - Street 1:1018 N BETHLEHEM PIKE STE AF
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2109
Mailing Address - Country:US
Mailing Address - Phone:215-206-1749
Mailing Address - Fax:
Practice Address - Street 1:1018 N BETHLEHEM PIKE STE AF
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2109
Practice Address - Country:US
Practice Address - Phone:215-206-1749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty