MAIN LINE MENTAL HEALTH LLC (NPI# 1083908388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083908388 |
| Entity Type | Organization |
| Organization Name | MAIN LINE MENTAL HEALTH LLC |
| Practice Address |
349 Lancaster Ave Suite 103 Haverford PA 19041-1500 |
| Mailing Address |
349 West Lancaster Avenue Suite 103 Haverford PA 19041-1500 |
| Practice Telephone | 6109455259 |
| Practice Fax Number | 6106647061 |
| Mailing Telephone | 6109455259 |
| Mailing Fax Number | 6106647061 |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2011-06-03 |
| Authorized Official Name | DR. JONATHAN GERSHON SHACK (SINGLE MEMBER LLC) |
| Authorized Official Telephone | 6109455259 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
MD04514OL | PA | Allopathic & Osteopathic Physicians |
| Street Address |
349 LANCASTER AVE SUITE 103 |
| City | HAVERFORD |
| State | PA |
| Zip Code | 19041-1500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710901384 | Cynthia Ann Galan | Psychologist | 349 Lancaster Ave, Ste 101, Haverford, PA 19041-1500 | 2006-07-27 |
| 1629432232 | Kathryn Elizabeth Angell Phd | Psychologist | 349 Lancaster Ave, Suite 101, Haverford, PA 19041-1500 | 2016-04-09 |
| 1467794479 | Barbara Zimmerman-slovak | Psychologist | 349 Lancaster Ave, Ste 104, Haverford, PA 19041-1500 | 2013-03-18 |
| 1679814792 | Time for Healing, LLC | Marriage & Family Therapist | 349 Lancaster Ave, Suite 101, Haverford, PA 19041-1500 | 2013-03-14 |
| 1477732105 | Robert Alan Schwarz | Psychologist | 349 Lancaster Ave, Suite 101, Haverford, PA 19041-1500 | 2007-10-30 |
| 1396963179 | David A. Reilly, D.m.d., P.C. | Dentist | 349 Lancaster Ave, Suite 100, Haverford, PA 19041-1500 | 2007-04-24 |
| 1225180318 | Elizabeth F Kleber | Psychologist | 349 Lancaster Ave, Suite 208, Haverford, PA 19041-1500 | 2007-01-17 |
| 1013074640 | Katherine Reed | Psychiatry & Neurology | 349 Lancaster Ave, Haverford, PA 19041-1500 | 2007-01-02 |
| 1477618338 | Oxycare Inc. | Pharmacy | 349 Lancaster Ave, Haverford, PA 19041-1500 | 2006-12-22 |
| 1255417564 | Annarita Gentile | Social Worker | 349 Lancaster Ave, Suite 200, Haverford, PA 19041-1500 | 2006-10-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285172999 | Linda G Tessler | Psychologist | 103 Green Lane, Haverford, PA 19041 | 2017-02-02 |
| 1255626529 | Haverford College Health Services | Registered Nurse | 370 Lancaster Avenue, Haverford, PA 19041 | 2011-06-15 |
| 1316256050 | Deborah Jean Gunton | Psychologist | 349 West Lancaster Avenue, Suite 201, Haverford, PA 19041 | 2010-09-29 |
| 1629390695 | Moira L Kowalczyk | Occupational Therapist | 551 West Lancaster Avenue, Haverford, PA 19041 | 2010-02-18 |
| 1528398724 | John Antoniades | Radiology | 404 Richard Knoll, Haverford, PA 19041 | 2010-01-11 |
| 1215264262 | Robert Frederick Plotkin | Pediatrics | 3300 Darby Rd., Apt 1310, Haverford, PA 19041 | 2009-11-12 |
| 1396984662 | Joel E Wasley | Dentist | 268 West Montgomery Avenue, Haverford, PA 19041 | 2009-02-11 |
| 1538325105 | Joseph Anthony Gwiszcz Jr. | Pediatrics | 600 Haverford Road., Suite 100, Haverford, PA 19041 | 2008-08-04 |
| 1619142262 | Gregory Stephen Wilson | Occupational Therapist | 551 W Lancaster Avenue, Staffing Plus, Haverford, PA 19041 | 2008-04-24 |
| 1972790319 | Lene H Larsen | Psychologist | 349 W. Lancaster Avenue, Suite 103, Haverford, PA 19041 | 2007-10-01 |
| Find all providers in zip 19041 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| 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. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922367820 | Charles A Altman | Psychiatry & Neurology | 632 Robinson Ln, Haverford, PA 19041-1927 | 2012-05-11 |
| 1821250275 | Ruth Sylvia Garfield | Psychiatry & Neurology | 355 Lancaster Ave # D, Haverford, PA 19041-1547 | 2008-06-26 |
| 1538326699 | John Alan Herring | Psychiatry & Neurology | 101 Cheswold Ln, Haverford, PA 19041-1865 | 2008-05-16 |
| 1770783938 | Susan E Rushing | Psychiatry & Neurology | 622 Haverford Rd, Haverford, PA 19041-1102 | 2007-07-24 |
| 1790995629 | Steven Marc Sokoll | Psychiatry & Neurology | 320 Quarry Ln, Haverford, PA 19041-1723 | 2007-05-22 |
| 1154541712 | Elena T Delbusto | Psychiatry & Neurology | 349 W. Lancaster Ave, Suite 206, Haverford, PA 19041 | 2007-04-26 |
| 1699841551 | Robert Eric Stake | Psychiatry & Neurology | 385 West Lancaster Avenue, Suite 207, Haverford, PA 19041-1551 | 2006-11-24 |
| 1407940323 | Gary Micheal Flaxenburg | Psychiatry & Neurology | 385 W. Lancaster Avenue, Haverford Square Suite 207, Haverford, PA 19041 | 2006-10-03 |
| 1760404669 | Steven M Eisen | Psychiatry & Neurology | 33 Meadows Ln, Haverford, PA 19041-1123 | 2006-07-23 |
| 1821028119 | Mohamed R. Dattu | Psychiatry & Neurology | 600 Haverford Rd Ste 201, Haverford, PA 19041-1139 | 2006-07-03 |
| Find all providers in HAVERFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.