Healthcare Provider Details

I. General information

NPI: 1629815030
Provider Name (Legal Business Name): ADAPTIVE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 NEVERLAND DR
MIDDLETOWN DE
19709-9948
US

IV. Provider business mailing address

369 NEVERLAND DR
MIDDLETOWN DE
19709-9948
US

V. Phone/Fax

Practice location:
  • Phone: 302-747-0939
  • Fax: 410-747-1866
Mailing address:
  • Phone: 302-747-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SARAH KEMUNTO ABUGAH
Title or Position: OWNER
Credential: NP
Phone: 302-747-0939