Provider Demographics
NPI:1215316344
Name:PSYCHIATRIC ASSOCIATES OF THE MAIN LINE, LLC
Entity type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF THE MAIN LINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-254-6363
Mailing Address - Street 1:101 E LANCASTER AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E LANCASTER AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3544
Practice Address - Country:US
Practice Address - Phone:484-254-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)