Provider Demographics
NPI:1346482841
Name:ADVANCED BEHAVIORAL CARE
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-565-1399
Mailing Address - Street 1:1223 N PROVIDENCE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1235
Mailing Address - Country:US
Mailing Address - Phone:610-565-1399
Mailing Address - Fax:610-565-0688
Practice Address - Street 1:1223 N PROVIDENCE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1235
Practice Address - Country:US
Practice Address - Phone:610-565-1399
Practice Address - Fax:610-565-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA024279Medicare UPIN