Provider Demographics
NPI:1457781809
Name:CHOP BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CHOP BEHAVIORAL HEALTH
Other - Org Name:CHOP CLINICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-590-5317
Mailing Address - Street 1:7700 GERMANTOWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118
Mailing Address - Country:US
Mailing Address - Phone:215-247-1172
Mailing Address - Fax:
Practice Address - Street 1:7700 GERMANTOWN AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118
Practice Address - Country:US
Practice Address - Phone:215-247-1172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOP CLINICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA SW1248301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty