Provider Demographics
NPI:1518464379
Name:A NEW SPIRIT BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:A NEW SPIRIT BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY-SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-772-3939
Mailing Address - Street 1:5745 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1236
Mailing Address - Country:US
Mailing Address - Phone:215-983-1488
Mailing Address - Fax:215-877-3529
Practice Address - Street 1:111 PRESIDENTIAL BLVD LBBY SUITE237
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1008
Practice Address - Country:US
Practice Address - Phone:610-772-3939
Practice Address - Fax:215-877-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW005909E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000236440OtherOPTUM