Healthcare Provider Details

I. General information

NPI: 1174830129
Provider Name (Legal Business Name): QUIETMIND FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 YORKTOWN PLZ
ELKINS PARK PA
19027-1420
US

IV. Provider business mailing address

140 YORKTOWN PLZ
ELKINS PARK PA
19027-1420
US

V. Phone/Fax

Practice location:
  • Phone: 610-940-0488
  • Fax: 215-359-0630
Mailing address:
  • Phone: 610-940-0488
  • Fax: 215-359-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARVIN HAROLD BERMAN
Title or Position: PRESIDENT
Credential: PHD
Phone: 610-940-0488