Provider Demographics
NPI:1629454442
Name:SOUTHEASTERN PENNSYLVANIA MENTAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN PENNSYLVANIA MENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEIBY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:610-905-3591
Mailing Address - Street 1:4271 N. DELAWARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040
Mailing Address - Country:US
Mailing Address - Phone:610-905-3591
Mailing Address - Fax:
Practice Address - Street 1:3735 NAZARETH ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-905-3591
Practice Address - Fax:610-258-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health