Provider Demographics
NPI:1154866309
Name:MID-ATLANTIC MENTAL HEALTH & WELLNESS SERVICES
Entity Type:Organization
Organization Name:MID-ATLANTIC MENTAL HEALTH & WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELIBERIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-805-1901
Mailing Address - Street 1:140 S BROADWAY
Mailing Address - Street 2:#7
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-2235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 S BROADWAY
Practice Address - Street 2:#7
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-2235
Practice Address - Country:US
Practice Address - Phone:844-365-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5677103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty