Provider Demographics
NPI:1992017479
Name:BANCROFT BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:BANCROFT BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC/MENTAL HEALTH NURSE PRA
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:STANFORD
Authorized Official - Last Name:WHY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:302-502-3255
Mailing Address - Street 1:1423 CAPITOL TRAIL DRUMMOND PLAZA OFFICE PARK
Mailing Address - Street 2:BUILDING 1, SUITE 1107
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711
Mailing Address - Country:US
Mailing Address - Phone:302-502-3255
Mailing Address - Fax:302-502-3257
Practice Address - Street 1:1423 CAPITOL TRAIL DRUMMOND PLAZA OFFICE PARK
Practice Address - Street 2:BUILDING 1, SUITE 1107
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-502-3255
Practice Address - Fax:302-502-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0000104363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty