Healthcare Provider Details

I. General information

NPI: 1063526689
Provider Name (Legal Business Name): WHITEMARSH BEHAVIORAL HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1800
US

IV. Provider business mailing address

1637 OAKWOOD DR APT S112
NARBERTH PA
19072-1004
US

V. Phone/Fax

Practice location:
  • Phone: 610-825-4450
  • Fax: 610-941-5532
Mailing address:
  • Phone: 610-825-4450
  • Fax: 610-941-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS002417L
License Number StatePA

VIII. Authorized Official

Name: THERESA SCHOLL
Title or Position: OWNER
Credential: PH.D
Phone: 610-825-4450