Provider Demographics
NPI:1659791440
Name:DELAWARE PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:DELAWARE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:KNOWELE
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:609-517-1529
Mailing Address - Street 1:27387 WALKING RUN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3086
Mailing Address - Country:US
Mailing Address - Phone:609-517-1529
Mailing Address - Fax:
Practice Address - Street 1:17021 OLD ORCHARD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4832
Practice Address - Country:US
Practice Address - Phone:609-517-1529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECD 0000020101YA0400X
DEPC 0000534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty