Healthcare Provider Details

I. General information

NPI: 1366371981
Provider Name (Legal Business Name): QUEEN'S VILLAGE INTEGRATIVE MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 DARBY RD STE 3C
HAVERTOWN PA
19083-4630
US

IV. Provider business mailing address

510 DARBY RD STE 3C
HAVERTOWN PA
19083-4630
US

V. Phone/Fax

Practice location:
  • Phone: 267-977-5249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CANDACE PERRY
Title or Position: APRN
Credential:
Phone: 267-977-5249