| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 51 Market St, Bangor, Pennsylvania |
| Authorized Official Name and Position | Carol Olzinski (ADMINISTRATOR) |
| Authorized Official Contact | 6105889109 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
400 Northampton St Suite 607 Easton PA 18042-3543 Ph: (610) 252-2000 | 51 Market St Bangor PA 18013-1901 Ph: (610) 588-9109 |
| NPI Number | 1043450455 |
|---|---|
| Provider Enumeration Date | 02/25/2009 |
| Last Update Date | 03/16/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043450455 | NPI | - | NPPES |
| 1001534600007 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 214210 (Pennsylvania) | Primary |
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