Healthcare Provider Details

I. General information

NPI: 1215548615
Provider Name (Legal Business Name): ELWYN OF PENNSYLVANIA AND DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ELWYN RD
MEDIA PA
19063-4622
US

IV. Provider business mailing address

111 ELWYN RD
MEDIA PA
19063-4622
US

V. Phone/Fax

Practice location:
  • Phone: 610-891-7007
  • Fax: 610-891-2666
Mailing address:
  • Phone: 610-891-7007
  • Fax: 610-891-2666

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOKE MCLAUGHLIN
Title or Position: CONTRACTS & CREDENTIALING COORD.
Credential:
Phone: 919-896-3581