MEDICARE: DELAWARE PSYCHOLOGICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CD 0000020	DE
2	101YM0800X	Mental Health Counselor	PC 0000534	DE

General Provider Information

NPI Number	:	1659791440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELAWARE PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	27387 WALKING RUN
Second Line	:
City	:	MILTON
State	:	DE
Zip	:	19968-3086
Country	:	US
Telephone Number	:	609-517-1529
Fax Number	:

Provider Business Practice Location Address
First Line	:	17021 OLD ORCHARD RD
Second Line	:	SUITE 4
City	:	LEWES
State	:	DE
Zip	:	19958-4832
Country	:	US
Telephone Number	:	609-517-1529
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. KATHERINE KNOWELE ELDER
Credential	:	PHD
Telephone Number	:	609-517-1529

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/21/2014

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