Provider Demographics
NPI:1801001938
Name:BUCKS COUNTY MENTAL HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:BUCKS COUNTY MENTAL HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:TORRES
Authorized Official - Last Name:MATRULLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-788-5730
Mailing Address - Street 1:1270 VETERANS HWY
Mailing Address - Street 2:SUITE F-10
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2588
Mailing Address - Country:US
Mailing Address - Phone:215-788-5730
Mailing Address - Fax:215-788-5737
Practice Address - Street 1:1270 VETERANS HWY
Practice Address - Street 2:SUITE F-10
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2588
Practice Address - Country:US
Practice Address - Phone:215-788-5730
Practice Address - Fax:215-788-5737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA126620251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101517530-0001Medicaid