NPIMap

Organization Active NPI

Aviva Mental Health Services

  • Adult Mental Health Clinic/Center
  • Collingdale, PA
National Provider Identifier
1760974679
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
144120 Issued in PA
Legal business name
AVIVA MENTAL HEALTH SERVICES
Practice address
17 S Macdade Blvd # 105
Collingdale, PA 19023-1510
Phone
(610) 522-4506
Fax
(610) 522-4508
NPI assigned
Jun 6, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

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

Authorized official

Name
Mrs. Susmaria Charles, MHS;CPSS
Title
Clinical Director
Phone
(610) 522-4506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 144120 PA Primary

Addresses

Primary practice location

17 S Macdade Blvd # 105
Collingdale, PA 19023-1510

Mailing address

17 S Macdade Blvd # 105
Collingdale, PA 19023-1510
Phone (610) 522-4506

Other identifiers 1

IdentifierTypeStateIssuer
144120MedicaidPA

Other names 1

  • Aviva Mental Health Services, Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Aviva Mental Health Serv6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

17 S Macdade Blvd
#105
Collingdale, PA 19023
Phone (610) 522-4506

NPI Registry JSON

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528243200000",
    "number": "1760974679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 S MACDADE BLVD # 105",
            "city": "COLLINGDALE",
            "state": "PA",
            "postal_code": "190231510",
            "telephone_number": "610-522-4506",
            "fax_number": "610-522-4508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 S MACDADE BLVD # 105",
            "city": "COLLINGDALE",
            "state": "PA",
            "postal_code": "190231510",
            "telephone_number": "610-522-4506",
            "fax_number": "610-522-4508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVIVA MENTAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-06",
        "last_updated": "2018-06-06",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "SUSMARIA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "610-522-4506",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MHS;CPSS"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "PA",
            "license": "144120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144120",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aviva Mental Health Services, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Aviva Mental Health Services, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Collingdale, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; 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.