Provider Demographics
NPI:1174559918
Name:A CENTER FOR HUMAN DEVELOPMENT LTD
Entity type:Organization
Organization Name:A CENTER FOR HUMAN DEVELOPMENT LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-736-1820
Mailing Address - Street 1:148 S. BRADFORD ST.
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-736-1820
Mailing Address - Fax:302-736-5016
Practice Address - Street 1:148 S. BRADFORD ST.
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-736-1820
Practice Address - Fax:302-736-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000004101YM0800X
DEQ1-00002491041C0700X
DEQ1-00005031041C0700X
DEQ1-00008311041C0700X
DEQ1-00001801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000032300Medicaid
DE1000032300Medicaid