Healthcare Provider Details

I. General information

NPI: 1285169664
Provider Name (Legal Business Name): DELAWARE INSTITUTE OF BEHAVIORAL SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 S STATE ST
DOVER DE
19901-7314
US

IV. Provider business mailing address

156 S STATE ST
DOVER DE
19901-7314
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2380
  • Fax: 302-674-1299
Mailing address:
  • Phone: 302-674-2380
  • Fax: 302-674-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateDE

VIII. Authorized Official

Name: LISA LEIDY
Title or Position: DIRECTOR
Credential:
Phone: 302-674-2380