Healthcare Provider Details

I. General information

NPI: 1518435114
Provider Name (Legal Business Name): COMMUNITY SERVICES OF DEVEREUX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEERFIELD LN STE 100
MALVERN PA
19355-2100
US

IV. Provider business mailing address

100 DEERFIELD LN STE 100
MALVERN PA
19355-2100
US

V. Phone/Fax

Practice location:
  • Phone: 610-933-8110
  • Fax: 610-933-7451
Mailing address:
  • Phone: 610-933-8110
  • Fax: 610-933-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH MCLAUGHLIN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 610-422-1463