State of Delaware

NPI #1104871920 in Dover, Delaware

Provider Information

NPI Number: 1104871920
Entity Type: Organization
Organization Name: State of Delaware
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: May 23, 2006
Last Updated: Feb 25, 2020

Practice Location

Address: 805 RIVER RD
City: Dover
State: Delaware
ZIP Code: 19901-3753
Phone: (302) 739-4275

Authorized Official

Name: MR. STANLEY J KOTULA
Title: MEDICAL DIRECTOR/DIRECTOR OF CLINIC
Phone: (302) 576-6093

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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