Healthcare Provider Details

I. General information

NPI: 1164864021
Provider Name (Legal Business Name): DELAWARE BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2013
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N JAMES ST SUITE 100 D
NEWPORT DE
19804-3169
US

IV. Provider business mailing address

240 N JAMES ST SUITE 100 D
NEWPORT DE
19804-3169
US

V. Phone/Fax

Practice location:
  • Phone: 302-543-4425
  • Fax: 302-543-5124
Mailing address:
  • Phone: 302-543-4425
  • Fax: 302-543-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License NumberLE-0000170
License Number StateDE

VIII. Authorized Official

Name: ERICA LYN BENEDICT
Title or Position: OFFICE/BUSINESS MANAGER
Credential:
Phone: 484-347-0517