Healthcare Provider Details

I. General information

NPI: 1336754951
Provider Name (Legal Business Name): EVERGREEN PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 S BOLMAR ST
WEST CHESTER PA
19382-4934
US

IV. Provider business mailing address

539 S BOLMAR ST
WEST CHESTER PA
19382-4934
US

V. Phone/Fax

Practice location:
  • Phone: 610-600-1289
  • Fax: 657-699-1816
Mailing address:
  • Phone: 610-600-1289
  • Fax: 657-699-1816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SARA HARMON
Title or Position: OWNER
Credential: MD
Phone: 610-600-1289