Healthcare Provider Details

I. General information

NPI: 1083110605
Provider Name (Legal Business Name): AVIVA MENTAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14-20 MACDADE BLVD STE A
COLLINGDALE PA
19023-1822
US

IV. Provider business mailing address

14-20 MACDADE BLVD STE A
COLLINGDALE PA
19023-1822
US

V. Phone/Fax

Practice location:
  • Phone: 610-522-4506
  • Fax: 610-522-4508
Mailing address:
  • Phone: 610-522-4506
  • Fax: 610-522-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number143750
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number143750
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number143750
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number143750
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number143750
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number143750
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number143750
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number143650
License Number StatePA
# 9
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number143750
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number143750
License Number StatePA
# 11
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number144120
License Number StatePA
# 12
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number143750
License Number StatePA
# 13
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number143750
License Number StatePA

VIII. Authorized Official

Name: MS. SUSMARIA CHARLES
Title or Position: CLINICAL DIRECTOR
Credential: MHS;CPSS
Phone: 610-522-4506