Healthcare Provider Details

I. General information

NPI: 1316768484
Provider Name (Legal Business Name): CEC MENTAL HEALTH CARE & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DARBY RD STE E4OFC3
PAOLI PA
19301-1475
US

IV. Provider business mailing address

2832 DEKALB PIKE # 1136
EAST NORRITON PA
19401-1823
US

V. Phone/Fax

Practice location:
  • Phone: 484-820-4470
  • Fax: 484-328-6377
Mailing address:
  • Phone: 484-820-4470
  • Fax: 484-328-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AISHA MOMOH
Title or Position: PROVIDER
Credential:
Phone: 484-820-4470