Provider Demographics
NPI:1538463922
Name:WHITEMARSH BEHAVIORAL HEALTHCARE INC
Entity Type:Organization
Organization Name:WHITEMARSH BEHAVIORAL HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-825-4450
Mailing Address - Street 1:600 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1800
Mailing Address - Country:US
Mailing Address - Phone:610-825-4450
Mailing Address - Fax:610-941-5532
Practice Address - Street 1:600 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1800
Practice Address - Country:US
Practice Address - Phone:610-825-4450
Practice Address - Fax:610-941-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW016839305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization