| Christiana Psychiatric Services Pa | |
|
4745 Ogletown-statnton Road Suite 124 Map 1 Newark DE 19713 | |
| (302) 454-9900 | |
| (302) 454-9905 |
| Full Name | Christiana Psychiatric Services Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4745 Ogletown-statnton Road, Newark, Delaware |
| Authorized Official Name and Position | Carol A Tavani (PRESIDENT) |
| Authorized Official Contact | 3024549900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Christiana Psychiatric Services Pa 4745 Ogletown-statnton Road Suite 124 Map 1 Newark DE 19713 Ph: (302) 454-9900 | Christiana Psychiatric Services Pa 4745 Ogletown-statnton Road Suite 124 Map 1 Newark DE 19713 Ph: (302) 454-9900 |
| NPI Number | 1225063720 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8921002726 |
|---|---|
| Medicare Enrollment ID | O20060911000204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225063720 | NPI | - | NPPES |
| 0000620002 | Medicaid | DE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Carol A Tavani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053386441 PECOS PAC ID: 0042106718 Enrollment ID: I20040227000656 |
| Provider Name | Alexander M Jacobson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639199169 PECOS PAC ID: 3173590114 Enrollment ID: I20040910000533 |
| Provider Name | Stephanie A Evans Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437547668 PECOS PAC ID: 4385960533 Enrollment ID: I20150305000728 |
| Provider Name | Cristina A Vardi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558565564 PECOS PAC ID: 7416973474 Enrollment ID: I20161206000748 |
| Provider Name | Margaret M Mack |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1962618686 PECOS PAC ID: 3577821628 Enrollment ID: I20171218002941 |
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