Healthcare Provider Details

I. General information

NPI: 1104170943
Provider Name (Legal Business Name): NEW HOPE PERSONAL DEVELOPMENT CENTRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SILVER TAIL LN.
NEW HOPE PA
18938-5763
US

IV. Provider business mailing address

140 SILVER TAIL LN.
NEW HOPE PA
18938-5763
US

V. Phone/Fax

Practice location:
  • Phone: 215-693-1010
  • Fax: 215-693-1128
Mailing address:
  • Phone: 215-693-1010
  • Fax: 215-693-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00306200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005928
License Number StatePA

VIII. Authorized Official

Name: MS. LINDA JEANNE ROONEY
Title or Position: OWNER/PRESIDENT
Credential: LPC
Phone: 215-375-6684