Provider Demographics
NPI:1346320983
Name:BRANDYWINE COUNSELING & COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:BRANDYWINE COUNSELING & COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-225-9269
Mailing Address - Street 1:2713 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-5220
Mailing Address - Country:US
Mailing Address - Phone:302-225-9267
Mailing Address - Fax:302-655-8920
Practice Address - Street 1:2713 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-5220
Practice Address - Country:US
Practice Address - Phone:302-225-9267
Practice Address - Fax:302-655-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-09-27
Deactivation Date:2022-08-30
Deactivation Code:
Reactivation Date:2022-09-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000884757Medicaid
DE1000024022Medicaid
DE0000047051Medicaid
DE235441Medicare PIN