Provider Demographics
NPI:1982039509
Name:THE EBRIGHT COLLABORATIVE, LLC
Entity Type:Organization
Organization Name:THE EBRIGHT COLLABORATIVE, LLC
Other - Org Name:THE EBRIGHT FOUNDATION, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DITTY
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW
Authorized Official - Phone:215-370-2821
Mailing Address - Street 1:607 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-4707
Mailing Address - Country:US
Mailing Address - Phone:302-888-2233
Mailing Address - Fax:302-888-2235
Practice Address - Street 1:607 W 18TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-4707
Practice Address - Country:US
Practice Address - Phone:215-370-2821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health