Provider Demographics
NPI:1013926583
Name:SOUTHAMPTON PSYCHIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTHAMPTON PSYCHIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-355-2011
Mailing Address - Street 1:1111 STREET RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4250
Mailing Address - Country:US
Mailing Address - Phone:215-355-2011
Mailing Address - Fax:215-396-1886
Practice Address - Street 1:1111 STREET RD
Practice Address - Street 2:SUITE 312
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4250
Practice Address - Country:US
Practice Address - Phone:215-355-2011
Practice Address - Fax:215-396-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0977468000OtherIBC
37920OtherHIGHMARK
779800OtherHIGHMARK
779800OtherHIGHMARK