Main Line Mental Health LLC
NPI #1083908388 in Haverford, Pennsylvania
Provider Information
- NPI Number
- 1083908388
- Entity Type
- Organization
- Organization Name
- Main Line Mental Health LLC
- Primary Specialty
- Psychiatry & Neurology - Psychiatry
- Enumeration Date
- Jun 3, 2011
- Last Updated
- Jun 3, 2011
Practice Location
- Address
- 349 LANCASTER AVE
- Address 2
- SUITE 103
- City
- Haverford
- State
- Pennsylvania
- ZIP Code
- 19041-1500
- Phone
- (610) 945-5259
Authorized Official
- Name
- DR. JONATHAN GERSHON SHACK, MD
- Title
- SINGLE MEMBER LLC
- Phone
- (610) 945-5259
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychiatry & Neurology - Psychiatry — Psychiatry |
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