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General NPI Number Information
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NPI Number | 1528385424
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Entity Type | Organization
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Legal Business Name | MAINLINE PSYCHCARE
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Dates
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Enumeration Date | 05/01/2010
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 210 MEETING HOUSE LN
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City | MERION STATION
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State | PA
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Zip | 19066-1203
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Country | US
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Telephone | 610-547-0473
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Fax |
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Provider Business Mailing Address
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Address Line | 210 MEETING HOUSE LN
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City | MERION STATION
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State | PA
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Zip | 19066-1203
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Country | US
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Telephone | 610-547-0473
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ROOMANA M SHEIKH
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Credential | MD
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Telephone | 619-547-0473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 447890669024
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License Number State | PA
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