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527 E Lancaster Ave Shillington PA 19607 | |
| (610) 796-8110 | |
| (610) 796-9130 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 527 E Lancaster Ave, Shillington, Pennsylvania |
| Authorized Official Name and Position | Salvatore Seth Modesto (DIRECTOR) |
| Authorized Official Contact | 6107968110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
527 E Lancaster Ave Shillington PA 19607-1364 Ph: (610) 796-8110 | 527 E Lancaster Ave Shillington PA 19607 Ph: (610) 796-8110 |
| NPI Number | 1831195932 |
|---|---|
| Provider Enumeration Date | 06/23/2005 |
| Last Update Date | 01/14/2025 |
| Certification Date | 01/14/2025 |
| Medicare PECOS PAC ID | 1759359540 |
|---|---|
| Medicare Enrollment ID | O20040920000854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831195932 | NPI | - | NPPES |
| 1007608410006 | Medicaid | PA | |
| AL923126 | Other | PA | HIGHMARK BLUE SHIELD |
| 1A50040191 | Other | PA | CAPITAL BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 205640 (Pennsylvania) | Primary |
| Provider Name | Maria T Reis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124195680 PECOS PAC ID: 3375694847 Enrollment ID: I20090623000340 |
| Provider Name | Salvatore S Modesto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063664860 PECOS PAC ID: 6709185176 Enrollment ID: I20160506000592 |
| Provider Name | Kadian Spence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538935838 PECOS PAC ID: 9739525411 Enrollment ID: I20240316000320 |
| Provider Name | Charlise Dalena Bell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336830264 PECOS PAC ID: 4082158399 Enrollment ID: I20240627002407 |
| Provider Name | Beth Anne Lamon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447082763 PECOS PAC ID: 7517407224 Enrollment ID: I20240909004076 |
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