Organization
AVIVA MENTAL HEALTH SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSMARIA CHARLES MHS (CEO)
(610) 522-4506
Entity
Organization
Contact information
Practice address
219 W 9TH ST, WILMINGTON, DE 19801-1619
(610) 522-4506
(610) 522-4508
Mailing address
320 MACDADE BLVD STE 205, DARBY, PA 19023-1926
(610) 522-4506
(610) 522-4508
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1034994870001
—
PA
Enumeration date
08/07/2020
Last updated
08/07/2020
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