| Diakon Family Life Services | |
|
435 W 4th St Williamsport PA 17701-6001 | |
| (570) 322-7873 | |
| (570) 322-8026 |
| Full Name | Diakon Family Life Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 435 W 4th St, Williamsport, Pennsylvania |
| Authorized Official Name and Position | Rita Rousseau (EXECUTIVE DIRECTOR COS) |
| Authorized Official Contact | 7177950368 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Diakon Family Life Services 435 W 4th St Williamsport PA 17701-6001 Ph: (570) 322-7873 | Diakon Family Life Services 435 W 4th St Williamsport PA 17701-6001 Ph: (570) 322-7873 |
| NPI Number | 1871537118 |
|---|---|
| Provider Enumeration Date | 06/16/2006 |
| Last Update Date | 11/11/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871537118 | NPI | - | NPPES |
| 301029 | Other | PA | VALUEOPTIONS |
| 1007777400036 | Medicaid | PA | |
| 1808012 | Other | PA | PA BS - LCSW FEP ONLY |
| 02319100 | Other | PA | CAPITAL BLUE CROSS |
| 080465 | Other | PA | FPH - PSYCHOLOGIST |
| 1443618 | Other | PA | PA BLUE SHIELD - PSYCHOLO |
| 1007777400006 | Medicaid | PA | |
| 1526223 | Other | PA | PA BLUE SHIELD - CRNP |
| 716009 | Other | PA | PA BLUE SHIELD - MD/DO |
| 803181 | Other | PW | FIRST PRIORITY HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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