NPIMap

Organization Active NPI

Senior Behavioral Healthcare Group, Inc

  • Cognitive & Behavioral Psychologist
  • Ardmore, PA
National Provider Identifier
1013930221
Registry record updated Jun 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
Legal business name
SENIOR BEHAVIORAL HEALTHCARE GROUP, INC
Practice address
25 Llanfair Cir
Ardmore, PA 19003-3342
Phone
(610) 649-6769
Fax
(619) 649-4190
NPI assigned
Jul 26, 2006
Last updated
Jun 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Manulyn Citron, PH.DNPI 1740395847
Title
Clinical Director
Phone
(610) 649-6769

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TB0200X Primary

Addresses

Primary practice location

25 Llanfair Cir
Ardmore, PA 19003-3342

Mailing address

25 Llanfair Cir
Ardmore, PA 19003-3342
Phone (610) 649-6769

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050217000717 PA Part B Supplier - Clinic/Group Practice 3476505447 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Reading, PA; Pittsburgh, PA; Monroeville, PA; Malvern, PA; Ephrata, PA; Devon, PA; Boyertown, PA; Blandon, PA…

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Senior Behavioral Healthcare Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1013930221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 LLANFAIR CIR",
            "city": "ARDMORE",
            "state": "PA",
            "postal_code": "190033342",
            "telephone_number": "610-649-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 LLANFAIR CIR",
            "city": "ARDMORE",
            "state": "PA",
            "postal_code": "190033342",
            "telephone_number": "610-649-6769",
            "fax_number": "619-649-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR BEHAVIORAL HEALTHCARE GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "CITRON",
        "authorized_official_first_name": "MANULYN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "610-649-6769",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.