Provider Demographics
NPI: | 1952561243 |
---|---|
Name: | D. L. FOREMANYE MENTAL HEALTH,INC. |
Entity Type: | Organization |
Organization Name: | D. L. FOREMANYE MENTAL HEALTH,INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DEVERA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | FOREMANYE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PSYCHOLOGIST |
Authorized Official - Phone: | 717-812-0118 |
Mailing Address - Street 1: | 9833 ENDORA CT |
Mailing Address - Street 2: | |
Mailing Address - City: | OWINGS MILLS |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21117-6216 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-812-0118 |
Mailing Address - Fax: | 410-363-4757 |
Practice Address - Street 1: | 140 ROOSEVELT AVE |
Practice Address - Street 2: | SUITE 205 |
Practice Address - City: | YORK |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17401-3333 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-812-0118 |
Practice Address - Fax: | 410-363-4757 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-06-11 |
Last Update Date: | 2008-06-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | PS007864L | 101YA0400X |
PA | PS007964L | 102L00000X, 103T00000X, 103TA0400X, 103TB0200X, 103TC1900X, 103TC2200X, 103TE1100X, 103TF0000X, 103TH0004X, 103TM1800X, 103TP2701X, 103TR0400X, 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Single Specialty |
No | 102L00000X | Behavioral Health & Social Service Providers | Psychoanalyst | Group - Single Specialty | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Single Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Single Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Single Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Single Specialty |
No | 103TE1100X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | Group - Single Specialty |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Single Specialty |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Single Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Single Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Single Specialty |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Single Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 001777321001 | Medicaid |