Provider Demographics
NPI:1164864021
Name:DELAWARE BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:DELAWARE BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-347-0517
Mailing Address - Street 1:240 N JAMES ST
Mailing Address - Street 2:SUITE 100 D
Mailing Address - City:NEWPORT
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3169
Mailing Address - Country:US
Mailing Address - Phone:302-543-4425
Mailing Address - Fax:302-543-5124
Practice Address - Street 1:240 N JAMES ST
Practice Address - Street 2:SUITE 100 D
Practice Address - City:NEWPORT
Practice Address - State:DE
Practice Address - Zip Code:19804-3169
Practice Address - Country:US
Practice Address - Phone:302-543-4425
Practice Address - Fax:302-543-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-20
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELE-0000170364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & FamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1316015696OtherNPI