Provider Demographics
NPI:1013381151
Name:DELAWARE COUNTY S.A.G.E.
Entity Type:Organization
Organization Name:DELAWARE COUNTY S.A.G.E.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:484-432-0742
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:PILGRIM GARDENS
Mailing Address - State:PA
Mailing Address - Zip Code:19026-0829
Mailing Address - Country:US
Mailing Address - Phone:484-432-0743
Mailing Address - Fax:
Practice Address - Street 1:205 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3052
Practice Address - Country:US
Practice Address - Phone:484-432-0743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-29
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014303251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health