Provider Demographics
NPI:1528385424
Name:MAINLINE PSYCHCARE
Entity Type:Organization
Organization Name:MAINLINE PSYCHCARE
Other - Org Name:MINDCARECONSULTING
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOMANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-547-0473
Mailing Address - Street 1:210 MEETING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1203
Mailing Address - Country:US
Mailing Address - Phone:610-547-0473
Mailing Address - Fax:
Practice Address - Street 1:210 MEETING HOUSE LN
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1203
Practice Address - Country:US
Practice Address - Phone:610-547-0473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-01
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA447890669024261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health