Provider Demographics
NPI:1851878847
Name:MAINLINE MENTAL HEALTH, WELLNESS & RECOVERY, LLC
Entity Type:Organization
Organization Name:MAINLINE MENTAL HEALTH, WELLNESS & RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-374-8626
Mailing Address - Street 1:2300 WALNUT ST APT 714
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-598-7517
Practice Address - Street 1:111 FORREST AVE FL 2
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2252
Practice Address - Country:US
Practice Address - Phone:724-374-8626
Practice Address - Fax:888-598-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty