Healthcare Provider Details

I. General information

NPI: 1518210699
Provider Name (Legal Business Name): DEERFIELD BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 STATE STREET
ERIE PA
16508
US

IV. Provider business mailing address

2808 STATE STREET
ERIE PA
16508
US

V. Phone/Fax

Practice location:
  • Phone: 824-456-2457
  • Fax: 824-456-7679
Mailing address:
  • Phone: 814-456-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. ROBERT DAVID BENACCI
Title or Position: THERAPIST
Credential: LPC
Phone: 814-456-2457