Organization
PHILADELPHIA MENTAL HEALTH CLINIC
Active
Other names
Delaware Valley Children's Center
Organization subpart
No
Provider details
NPI number
Authorized official
JASON CARROLL (BUSINESS MANAGER)
(215) 735-9379
Entity
Organization
Contact information
Practice address
1235 PINE STREET, PHILADELPHIA, PA 19107-5945
(215) 598-0223
(215) 598-9020
Mailing address
1235 PINE STREET, PHILADELPHIA, PA 19107-5945
(215) 598-0223
(215) 598-9020
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
123880
PA
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000138598
BCBS
PA
01
—
0056455000
BC
PA
05
—
1007279540006
—
PA
01
—
265050000
MAGELLAN BEHAVIORAL HEALT
PA
Enumeration date
12/14/2006
Last updated
09/10/2015
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