Healthcare Provider Details

I. General information

NPI: 1376911081
Provider Name (Legal Business Name): MAIN LINE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 1/2 FORREST AVE STE 7
NARBERTH PA
19072-2220
US

IV. Provider business mailing address

104 1/2 FORREST AVE STE 7
NARBERTH PA
19072-2220
US

V. Phone/Fax

Practice location:
  • Phone: 724-374-8626
  • Fax: 888-598-7517
Mailing address:
  • Phone: 724-374-8626
  • Fax: 888-598-7517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMD 438014
License Number StatePA

VIII. Authorized Official

Name: HUMA MAHMOOD
Title or Position: PSYCHIATRIST
Credential:
Phone: 724-374-8626