NPIMap

Organization Active NPI

Malvern Constitution LLC

Doing business as Malvern Behavioral Health

  • Psychiatry Physician
  • Philadelphia, PA
National Provider Identifier
1952268195
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MALVERN CONSTITUTION LLC
Doing business as
Malvern Behavioral Health
Practice address
1930 S Broad St
Philadelphia, PA 19145-2328
Phone
(610) 480-8919
Fax
(610) 480-8944
NPI assigned
Jan 8, 2026
Last updated
Jan 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

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

Authorized official

Name
Glenn Gabris
Title
Chief Financial Officer
Phone
(610) 941-3390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1930 S Broad St
Philadelphia, PA 19145-2328

Mailing address

2 Valley Square
512 E Township Line Road, Suite 115
Philadelphia, PA 19422-2700
Phone (610) 941-3390

Other practice location 1

3905 Ford Rd
Philadelphia, PA 19131-2824
Phone (610) 480-8919

Other names 1

  • Malvern Behavioral Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260306001809 PA Part B Supplier - Clinic/Group Practice 0648606681 Receives reassigned benefits from 10 practitioners
Practice locations: Philadelphia, PA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Malvern Constitution LLC2 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.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
PharmericaPhiladelphia, PA, CCN 396141 Skilled nursing facility Operational/Managerial Control Dec 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 11

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": "1767830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1952268195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 VALLEY SQUARE",
            "address_2": "512 E TOWNSHIP LINE ROAD, SUITE 115",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "194222700",
            "telephone_number": "610-941-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452328",
            "telephone_number": "610-480-8919",
            "fax_number": "610-480-8944"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3905 Ford Rd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191312824",
            "country_code": "US",
            "telephone_number": "610-480-8919",
            "fax_number": "610-480-8944",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MALVERN CONSTITUTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-08",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "GABRIS",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "610-941-3390"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malvern Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.