Organization
MAIN LINE INTEGRATIVE PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY ROBERT DEROSA MD (OWNER)
(484) 222-0314
Entity
Organization
Contact information
Practice address
10 UNION AVE APT 301, BALA CYNWYD, PA 19004-3421
(484) 222-0314
Mailing address
10 UNION AVE APT 301, BALA CYNWYD, PA 19004-3421
(484) 222-0314
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
10/13/2025
Last updated
10/13/2025
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