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MAIN LINE AFFILIATES NPI 1083777239


NPI Information

NPI: 1083777239
Provider Name: MAIN LINE AFFILIATES

Other Name: MAIN LINE BEHAVIORAL HEALTH AFFILIATES

Classification: Psychiatry & Neurology - 2084P0800X
Entity Type: Organization

Specialization: Psychiatry

Address:
1 RADNOR CORPORATE CTR
SUITE 400
RADNOR, PA
ZIP 19087
Phone: (610) 254-1450
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MAIN LINE AFFILIATES is a psychiatry psychiatry neurology in Radnor, PA. The provider is a Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. MAIN LINE AFFILIATES NPI is 1083777239. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Main Line Behavioral Health Affiliates.

The provider's business location address is:

1 RADNOR CORPORATE CTR
SUITE 400
RADNOR, PA
ZIP 19087-515
Phone: (610) 254-1450

The provider's authorized official is Michael J Buongiorno .
The authorized official title is Exec. Vp & Cfo and has the following contact phone number (484) 337-8481.

The enumeration date for this NPI number is 12/19/2006 and was last updated on 5/18/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103G00000XClinical NeuropsychologistNo
2103T00000XPsychologistNo
3261QR0405XClinic/CenterRehabilitation, Substance Use Disorder237078PENNSYLVANIANo
4261QR0405XClinic/CenterRehabilitation, Substance Use Disorder151081PENNSYLVANIANo
5103TC0700XPsychologistClinicalNo
6103TR0400XPsychologistRehabilitationNo
7101YA0400XCounselorAddiction (Substance Use Disorder)No
82084P0802XPsychiatry & NeurologyAddiction PsychiatryNo
92084P0804XPsychiatry & NeurologyChild & Adolescent PsychiatryNo
10261QM0850XClinic/CenterAdult Mental HealthNo
112084P0800XPsychiatry & NeurologyPsychiatryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12089835OTHERCIGNA - CAD EXTON
2087890MEDICARE ID-TYPE UNSPECIFIED
3280110000OTHERMAGELLAN - CAD DREXEL HIL
4293195OTHERVALUEOPTIONS - MLA
57985197OTHERAETNA PPO - MLA
61007726370011MEDICAIDPENNSYLVANIA
7101825OTHERUNITED - CAD ADOLESCENT
8231200000OTHERMAGELLAN - CAD EXTON
92983910OTHERAETNA HMO - CAD EXTON
10101824OTHERUNITED - CAD ADULT IOP
112089834OTHERCIGNA - CAD DREXEL HILL
120470009OTHERAETNA HMO - BMR PSYCH
130664704000OTHERIBC - BMR PSYCH ASSOC
14101823OTHERUNITED - CAD - ADULT PHP
152317419000OTHERIBC - MLA
16471443000OTHERMAGELLAN - MLA
172983830OTHERAETNA HMO - CAD DREX HILL

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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