Healthcare Provider Details

I. General information

NPI: 1952485864
Provider Name (Legal Business Name): DELAWARE COUNTY PROFESSIONAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E BALTIMORE PIKE STE 303
MEDIA PA
19063-5173
US

IV. Provider business mailing address

1055 E BALTIMORE PIKE STE 303
MEDIA PA
19063-5173
US

V. Phone/Fax

Practice location:
  • Phone: 610-892-3800
  • Fax: 484-468-1412
Mailing address:
  • Phone: 610-892-3800
  • Fax: 484-468-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RYAN PARDO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 206-399-1493