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General NPI Number Information
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NPI Number | 1306962691
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Entity Type | Organization
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Legal Business Name | ELWYN OF PENNSYLVANIA AND DELAWARE
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 2502 SILVERSIDE RD STE 4
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City | WILMINGTON
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State | DE
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Zip | 19810-3740
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Country | US
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Telephone | 302-300-6557
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Fax |
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Provider Business Mailing Address
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Address Line | 111 ELWYN RD
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City | MEDIA
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State | PA
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Zip | 19063-4622
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Country | US
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Telephone | 610-497-8972
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Fax | 610-485-3965
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Authorized Official
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Title or Position | DIR. OF CONTRACTS AND CREDENTIALING
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Name | MRS. DONNA BUSCH
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Credential |
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Telephone | 445-206-3028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225CX0006X
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Taxonomy Name | Orientation and Mobility Training Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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