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1120 W Township Line Rd Ste 101 Havertown PA 19083-4930 | |
| (267) 784-5118 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1120 W Township Line Rd Ste 101, Havertown, Pennsylvania |
| Authorized Official Name and Position | Richard F Cubbage (MANAGING MEMBER) |
| Authorized Official Contact | 2677845118 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8330 Fenton Rd Glenside PA 19038-7146 Ph: (267) 784-5118 | 1120 W Township Line Rd Ste 101 Havertown PA 19083-4930 Ph: (267) 784-5118 |
| NPI Number | 1518737824 |
|---|---|
| Provider Enumeration Date | 01/08/2024 |
| Last Update Date | 01/28/2025 |
| Certification Date | 01/28/2025 |
| Medicare PECOS PAC ID | 8123566155 |
|---|---|
| Medicare Enrollment ID | O20240821001862 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518737824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Alissa Lynn Delgrosso |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063162162 PECOS PAC ID: 3173061116 Enrollment ID: I20240821002120 |
| Provider Name | Heather Ann Grinar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992009534 PECOS PAC ID: 4587102512 Enrollment ID: I20240821002619 |
| Provider Name | Jason Matthew Kirk |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720518327 PECOS PAC ID: 9133652530 Enrollment ID: I20241023003886 |
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