1659791440 NPI number — DELAWARE PSYCHOLOGICAL SERVICES LLC

Table of content: (NPI 1659791440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659791440 NPI number — DELAWARE PSYCHOLOGICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE PSYCHOLOGICAL SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659791440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27387 WALKING RUN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19968-3086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-517-1529
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17021 OLD ORCHARD RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-517-1529
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ELDER
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
KNOWELE
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
609-517-1529

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CD 0000020 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: PC 0000534 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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