Provider Demographics
NPI:1629615810
Name:GANIM PSYCHOLOGY AND BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:GANIM PSYCHOLOGY AND BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MENDY
Authorized Official - Middle Name:LYNN VIEL
Authorized Official - Last Name:GANIM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-350-6092
Mailing Address - Street 1:30 S VALLEY RD STE 123B
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 WEST WELSH POOL ROAD, SUITE 204 SOUTH
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1233
Practice Address - Country:US
Practice Address - Phone:610-350-6092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty