Provider Demographics
NPI:1184977431
Name:EXTON BEHAVIORAL HEALTH & REHABILITATION
Entity type:Organization
Organization Name:EXTON BEHAVIORAL HEALTH & REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-214-2090
Mailing Address - Street 1:506 EXTON CMNS
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2452
Mailing Address - Country:US
Mailing Address - Phone:610-214-2090
Mailing Address - Fax:610-214-2091
Practice Address - Street 1:506 EXTON CMNS
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2452
Practice Address - Country:US
Practice Address - Phone:610-214-2090
Practice Address - Fax:610-214-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008758L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007631130OtherBC/BS
PA2368066000OtherPERSONAL CHOICE