Provider Demographics
NPI:1609839620
Name:DALTON, HAROLD S JR (MSW, LCSW, CADC)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:S
Last Name:DALTON
Suffix:JR
Gender:M
Credentials:MSW, LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VETERANS SQ STE 200
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3129
Mailing Address - Country:US
Mailing Address - Phone:610-565-2690
Mailing Address - Fax:610-565-2695
Practice Address - Street 1:24 VETERAN SQUARE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3101
Practice Address - Country:US
Practice Address - Phone:610-565-2690
Practice Address - Fax:610-565-2695
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4530101YA0400X
DEQ100005161041C0700X
PACW0138541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010175980001Medicaid
PA102080464OtherUNITED BEHAVIORAL HEALTH
PA1010175980002Medicaid
PA7600130OtherAETNA
PADA1658217OtherHIGHMARK BC/BS
PAMIS 171545000OtherMAGELLAN
PA9730OtherPENN BEHAVIORAL HEALTH
PA2318608OtherPERSONAL CHOICE
PA234586OtherCOMPSYCH
PA351291OtherMANAGED HEALTH - TRICARE
PA149079 - A917651OtherVALUE OPTIONS
PA600881Medicare ID - Type Unspecified