Healthcare Provider Details

I. General information

NPI: 1053203505
Provider Name (Legal Business Name): BALANCED BEHAVIORAL HEALTH & WELLNESS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 KENNETT PIKE STE 500
CHADDS FORD PA
19317-7393
US

IV. Provider business mailing address

512 KENNETT PIKE STE 500
CHADDS FORD PA
19317-7393
US

V. Phone/Fax

Practice location:
  • Phone: 215-870-6687
  • Fax: 610-968-1676
Mailing address:
  • Phone: 215-870-6687
  • Fax: 610-968-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK ANTHONY NOVITSKY JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 215-870-6687