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Contact Information

MAIN LINE AFFILIATES
1 RADNOR CORPORATE CTR
SUITE 400
RADNOR, PA19087-4515
 Phone: 610-254-1450
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Addiction (Substance Use Disorder)

101YA0400X
 

Addiction Psychiatry

2084P0802X 86 Physician/Neuropsychiatry
 

Adult Mental Health

261QM0850X
 

Child & Adolescent Psychiatry

2084P0804X 86 Physician/Neuropsychiatry
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

Clinical Neuropsychologist

103G00000X
 

Psychologist

103T00000X 62 Psychologist, Clinical
 

Rehabilitation

103TR0400X 62 Psychologist, Clinical
 

Rehabilitation, Substance Use Disorder

261QR0405X
Indicates primary specialty

NPI Profile & details for MAIN LINE AFFILIATES · (Female)

NPI # 1083777239
Status Active
Credentials
Entity Individual
Enumeration date 12/19/2006
Last updated 05/18/2016 - About 10 years ago
Sole proprietor 1 Not specified
Identifiers
  • PA License # 151081
  • PA License # 237078
  • PA Medicaid 1007726370011
  • Other 0470009 AETNA HMO - BMR PSYCH
  • Other 2983830 AETNA HMO - CAD DREX HILL
  • Other 2983910 AETNA HMO - CAD EXTON
  • Other 7985197 AETNA PPO - MLA
  • Other 2089834 CIGNA - CAD DREXEL HILL
  • Other 2089835 CIGNA - CAD EXTON
  • Other 0664704000 IBC - BMR PSYCH ASSOC
  • Other 2317419000 IBC - MLA
  • Other 280110000 MAGELLAN - CAD DREXEL HIL
  • Other 231200000 MAGELLAN - CAD EXTON
  • Other 471443000 MAGELLAN - MLA
  • Other 101823 UNITED - CAD - ADULT PHP
  • Other 101825 UNITED - CAD ADOLESCENT
  • Other 101824 UNITED - CAD ADULT IOP
  • Other 293195 VALUEOPTIONS - MLA
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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