| Colonial Intermediate Unit 20 | |
|
Route 209 Pleasant Valley High School Brodheadsville PA 18322-9715 | |
| (610) 515-6477 | |
| (610) 515-6457 |
| Full Name | Colonial Intermediate Unit 20 |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | Route 209, Brodheadsville, Pennsylvania |
| Authorized Official Name and Position | Christopher Wolfel (EXECUTOR DIRECTOR) |
| Authorized Official Contact | 6102525550 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Colonial Intermediate Unit 20 6 Danforth Rd Easton PA 18045-7820 Ph: (610) 252-5550 | Colonial Intermediate Unit 20 Route 209 Pleasant Valley High School Brodheadsville PA 18322-9715 Ph: (610) 515-6477 |
| NPI Number | 1295017770 |
|---|---|
| Provider Enumeration Date | 09/12/2011 |
| Last Update Date | 02/09/2021 |
| Certification Date | 02/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295017770 | NPI | - | NPPES |
| 100754460 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 235100 (Pennsylvania) | Primary |
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