Organization Active NPI

Main Line Affiliates

Psychiatry Physician
Radnor, PA

National Provider Identifier

1083777239

Registry record updated May 18, 2016

On this page

Key facts
NPPES NPI Registry
National Provider Directory
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Radnor, PA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name: MAIN LINE AFFILIATES
Practice address: 1 Radnor Corporate Ctr
Suite 400
Radnor, PA 19087-4515
Phone: (610) 254-1450
NPI assigned: Dec 19, 2006
Organization subpart: No

NPPES NPI Registry

Updated by the provider on May 18, 2016

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

Authorized official

Name: Mr. Michael J Buongiorno
Title: Exec. VP & Cfo
Phone: (484) 337-8481

Specialties & licenses 11

Specialty (taxonomy)	Code	License	State	Primary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP	101YA0400X
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP	103G00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP	103T00000X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP	103TC0700X
Rehabilitation PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP	103TR0400X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	2084P0800X			Primary
Addiction Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	2084P0802X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	2084P0804X
Adult Mental Health Clinic/Center	261QM0850X
Substance Use Disorder Rehabilitation Clinic/Center	261QR0405X	237078	PA
Substance Use Disorder Rehabilitation Clinic/Center	261QR0405X	151081	PA

Addresses

Primary practice location

1 Radnor Corporate Ctr
Suite 400
Radnor, PA 19087-4515

Mailing address

950 E Haverford Rd
Suite 110
Bryn Mawr, PA 19010-3850
Phone (610) 526-8480

Other identifiers 16

Identifier	Type	State	Issuer
293195	Other		VALUEOPTIONS - MLA
471443000	Other		MAGELLAN - MLA
2089835	Other		CIGNA - CAD EXTON
2983830	Other		AETNA HMO - CAD DREX HILL
2089834	Other		CIGNA - CAD DREXEL HILL
231200000	Other		MAGELLAN - CAD EXTON
280110000	Other		MAGELLAN - CAD DREXEL HIL
0664704000	Other		IBC - BMR PSYCH ASSOC
1007726370011	Medicaid	PA
101825	Other		UNITED - CAD ADOLESCENT
2317419000	Other		IBC - MLA
101823	Other		UNITED - CAD - ADULT PHP
101824	Other		UNITED - CAD ADULT IOP
2983910	Other		AETNA HMO - CAD EXTON
0470009	Other		AETNA HMO - BMR PSYCH
7985197	Other		AETNA PPO - MLA

Other names 1

Main Line Behavioral Health Affiliates Other name

National Provider Directory

Locations

1 Radnor Corporate Ctr
Ste 400
Radnor, PA 19087
Phone (610) 254-1450

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

George Abraham, PC
- Psychiatry Physician
- Lafayette Hill, PA
- NPI 1679552368
NPD (past)
Charles A Altman, M.D.
- Psychiatry Physician
- Haverford, PA
- NPI 1922367820
NPD (past)
Carol L Armstrong, PH.D., ABPN
- Clinical Neuropsychologist
- Philadelphia, PA
- NPI 1407879430
NPD (past)
Rebecca Canna, PSY.D.
- Psychologist
- Philadelphia, PA
- NPI 1184886566
NPD (past)
Lisa Cerullo, MSW, MHS
- Addiction (Substance Use Disorder) Counselor
- Chester Springs, PA
- NPI 1205062510
NPD (past)
Roel D Compendio, MD
- Psychiatry Physician
- Paoli, PA
- NPI 1902885296
NPD (past)
Barbara Elaine Foxman, LCSW
- Clinical Social Worker
- Lafayette Hill, PA
- NPI 1720065667
NPD (past)
Susan Fralick-Ball, PSYD, MSN
- Clinical Psychologist
- Blue Bell, PA
- NPI 1053696161
Clinical Neuropsychologist
NPD (past)
David Goodwin, PHD
- Psychologist
- Philadelphia, PA
- NPI 1265512362
NPD (past)
Leah Greenwood, PH.D.
- Psychologist
- Exton, PA
- NPI 1790763845
NPD (past)
Steven D. Hulcher
- Psychologist
- Exton, PA
- NPI 1255319307
NPD (past)
Lisa C Jacobson, PSY.D.
- Clinical Psychologist
- Newtown, PA
- NPI 1982865424
NPD (past)

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1083777239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 E HAVERFORD RD",
            "address_2": "SUITE 110",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103850",
            "telephone_number": "610-526-8480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RADNOR CORPORATE CTR",
            "address_2": "SUITE 400",
            "city": "RADNOR",
            "state": "PA",
            "postal_code": "190874515",
            "telephone_number": "610-254-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN LINE AFFILIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2016-05-18",
        "status": "A",
        "authorized_official_last_name": "BUONGIORNO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXEC. VP & CFO",
        "authorized_official_telephone_number": "484-337-8481",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "PA",
            "license": "237078",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "PA",
            "license": "151081",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS - MLA",
            "identifier": "293195",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN - MLA",
            "identifier": "471443000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA - CAD EXTON",
            "identifier": "2089835",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO - CAD DREX HILL",
            "identifier": "2983830",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA - CAD DREXEL HILL",
            "identifier": "2089834",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN - CAD EXTON",
            "identifier": "231200000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN - CAD DREXEL HIL",
            "identifier": "280110000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC - BMR PSYCH ASSOC",
            "identifier": "0664704000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007726370011",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED - CAD ADOLESCENT",
            "identifier": "101825",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC - MLA",
            "identifier": "2317419000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED - CAD - ADULT PHP",
            "identifier": "101823",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED - CAD ADULT IOP",
            "identifier": "101824",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO - CAD EXTON",
            "identifier": "2983910",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO - BMR PSYCH",
            "identifier": "0470009",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO - MLA",
            "identifier": "7985197",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Line Behavioral Health Affiliates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Radnor, PA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.