Provider Demographics
NPI:1861630188
Name:PORT IN THE STORM LLC
Entity Type:Organization
Organization Name:PORT IN THE STORM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-735-7738
Mailing Address - Street 1:600 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2702
Mailing Address - Country:US
Mailing Address - Phone:302-735-7738
Mailing Address - Fax:302-735-8560
Practice Address - Street 1:600 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2702
Practice Address - Country:US
Practice Address - Phone:302-735-7738
Practice Address - Fax:302-735-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0000296251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000021573Medicaid
DE1000021573Medicaid