MEDICARE: RESILIENT KIDS CHILD & FAMILY THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PC-0000769	DE

General Provider Information

NPI Number	:	1487130159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESILIENT KIDS CHILD & FAMILY THERAPY

Provider Business Mailing Address
First Line	:	801 MAPLETON AVE
Second Line	:
City	:	MIDDLETOWN
State	:	DE
Zip	:	19709-0057
Country	:	US
Telephone Number	:	302-279-6491
Fax Number	:	302-376-6145

Provider Business Practice Location Address
First Line	:	801 MAPLETON AVE
Second Line	:
City	:	MIDDLETOWN
State	:	DE
Zip	:	19709-0057
Country	:	US
Telephone Number	:	302-279-6491
Fax Number	:	302-376-6145

Authorized Official
Title or Position	:	OWNER
Name	:	MARISSA LLOYD
Credential	:	LPCMH
Telephone Number	:	302-279-6491

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	06/05/2025

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