Organization
MIND-BODY MANAGEMENT, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLI J DEIACO PHD (PRESIDENT)
(610) 462-5585
Entity
Organization
Contact information
Practice address
108 S CHURCH ST, MACUNGIE, PA 18062-1038
(610) 462-5585
(610) 966-5616
Mailing address
108 S CHURCH ST, MACUNGIE, PA 18062-1038
(610) 462-5585
(610) 966-5616
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
PC004790
PA
Other
Enumeration date
03/26/2009
Last updated
06/15/2009
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