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General NPI Number Information
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NPI Number | 1518737824
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Entity Type | Organization
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Legal Business Name | DTAP MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1120 W TOWNSHIP LINE RD STE 101
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City | HAVERTOWN
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State | PA
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Zip | 19083-4930
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Country | US
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Telephone | 267-784-5118
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Fax |
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Provider Business Mailing Address
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Address Line | 8330 FENTON RD
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City | GLENSIDE
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State | PA
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Zip | 19038-7146
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Country | US
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Telephone | 267-784-5118
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. RICHARD F CUBBAGE JR.
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Credential |
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Telephone | 267-784-5118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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