Healthcare Provider Details

I. General information

NPI: 1689748428
Provider Name (Legal Business Name): PHOENIX BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 S BRADFORD ST
DOVER DE
19904-4141
US

IV. Provider business mailing address

PO BOX 1081
DOVER DE
19903-1081
US

V. Phone/Fax

Practice location:
  • Phone: 302-736-6135
  • Fax: 302-736-0172
Mailing address:
  • Phone: 302-736-6135
  • Fax: 302-736-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN FRIEDMAN
Title or Position: CEO
Credential:
Phone: 302-736-6135