Provider Demographics
NPI:1225063720
Name:CHRISTIANA PSYCHIATRIC SERVICES PA
Entity Type:Organization
Organization Name:CHRISTIANA PSYCHIATRIC SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-454-9900
Mailing Address - Street 1:4745 OGLETOWN-STATNTON ROAD
Mailing Address - Street 2:SUITE 124 MAP 1
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-454-9900
Mailing Address - Fax:302-454-9905
Practice Address - Street 1:4745 OGLETOWN-STATNTON ROAD
Practice Address - Street 2:SUITE 124 MAP 1
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-454-9900
Practice Address - Fax:302-454-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000620002Medicaid
DE0000620002Medicaid