Provider Demographics
NPI:1376911081
Name:MAIN LINE MENTAL HEALTH
Entity Type:Organization
Organization Name:MAIN LINE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DANISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-597-9693
Mailing Address - Street 1:111 FORREST AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2251
Mailing Address - Country:US
Mailing Address - Phone:610-597-9693
Mailing Address - Fax:888-960-2779
Practice Address - Street 1:111 FORREST AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2251
Practice Address - Country:US
Practice Address - Phone:610-597-9693
Practice Address - Fax:888-960-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 438014251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health