Provider Demographics
NPI:1013384254
Name:DELAWARE COUNTY PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:DELAWARE COUNTY PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-892-3800
Mailing Address - Street 1:3302 TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1412
Mailing Address - Country:US
Mailing Address - Phone:215-913-5350
Mailing Address - Fax:
Practice Address - Street 1:3302 TILDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1412
Practice Address - Country:US
Practice Address - Phone:215-913-5350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0140231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty