Healthcare Provider Details

I. General information

NPI: 1538463922
Provider Name (Legal Business Name): WHITEMARSH BEHAVIORAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
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

600 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1800
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 Code305R00000X
TaxonomyPreferred Provider Organization
License NumberCW016839
License Number StatePA

VIII. Authorized Official

Name: MRS. KIM MARCELLINO
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-825-4450