Provider Demographics
NPI:1619291663
Name:THORNSBERRY BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:THORNSBERRY BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:THORNSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:302-858-2019
Mailing Address - Street 1:750 KINGS HWY
Mailing Address - Street 2:SUITE 101-B
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1772
Mailing Address - Country:US
Mailing Address - Phone:302-858-2019
Mailing Address - Fax:302-644-6953
Practice Address - Street 1:750 KINGS HWY
Practice Address - Street 2:SUITE 101-B
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1772
Practice Address - Country:US
Practice Address - Phone:302-858-2019
Practice Address - Fax:302-644-6953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0000975251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE156814ZF6AMedicare UPIN