Basic Information
| Provider Information | |||||||||
| NPI: | 1316191240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELAWARE HOUSE MENTAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 IKEA DR | ||||||||
| Address2: | |||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080605115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092679339 | ||||||||
| FaxNumber: | 6092676655 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 IKEA DR | ||||||||
| Address2: | |||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080605115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092679339 | ||||||||
| FaxNumber: | 6092676655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 11/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | REDILLA | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CASE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6092679339 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | BS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.