Provider Demographics
NPI:1497914089
Name:SENIOR BEHAVIORAL HEALTHCARE GROUP INC
Entity Type:Organization
Organization Name:SENIOR BEHAVIORAL HEALTHCARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANULYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CITRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-649-6769
Mailing Address - Street 1:25 LLANFAIR CIR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-3342
Mailing Address - Country:US
Mailing Address - Phone:610-649-6769
Mailing Address - Fax:610-649-4190
Practice Address - Street 1:25 LLANFAIR CIR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-3342
Practice Address - Country:US
Practice Address - Phone:610-649-6769
Practice Address - Fax:610-649-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA049490Medicare PIN