| Innovative Therapy Services, Llc | |
|
3939 W Ridge Rd Suite B-45 Erie PA 16506-1879 | |
| (814) 240-1011 | |
| (814) 240-1048 |
| Full Name | Innovative Therapy Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3939 W Ridge Rd, Erie, Pennsylvania |
| Authorized Official Name and Position | Shana Lynn Bennett (PARTNER) |
| Authorized Official Contact | 8142401011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Therapy Services, Llc 3939 W Ridge Rd Suite B-45 Erie PA 16506-1879 Ph: (814) 240-1011 | Innovative Therapy Services, Llc 3939 W Ridge Rd Suite B-45 Erie PA 16506-1879 Ph: (814) 240-1011 |
| NPI Number | 1982043394 |
|---|---|
| Provider Enumeration Date | 06/19/2013 |
| Last Update Date | 02/16/2015 |
| Medicare PECOS PAC ID | 3870729932 |
|---|---|
| Medicare Enrollment ID | O20131119001051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982043394 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | PC005212 (Pennsylvania) | Secondary |
| 1041C0700X | Social Worker - Clinical | CW016017 (Pennsylvania) | Primary |
| Provider Name | Shana L Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730523192 PECOS PAC ID: 3779719836 Enrollment ID: I20131119001174 |
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