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24727 Route 6 Ste 2 Towanda PA 18848-8257 | |
| (570) 265-0100 | |
| (570) 265-6741 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 24727 Route 6 Ste 2, Towanda, Pennsylvania |
| Authorized Official Name and Position | Paul Denault (CEO) |
| Authorized Official Contact | 5702650100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
24727 Route 6 Ste 2 Towanda PA 18848-8257 Ph: (570) 265-0100 | 24727 Route 6 Ste 2 Towanda PA 18848-8257 Ph: (570) 265-0100 |
| NPI Number | 1346267374 |
|---|---|
| Provider Enumeration Date | 07/16/2006 |
| Last Update Date | 03/25/2015 |
| Medicare PECOS PAC ID | 7113997354 |
|---|---|
| Medicare Enrollment ID | O20040727000681 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346267374 | NPI | - | NPPES |
| 1007540580075 | Medicaid | PA | |
| 1007540580040 | Medicaid | PA | |
| 753722 | Other | PA | HIGHMARK BLUE SHIELD |
| 1007540580042 | Medicaid | PA | |
| 801928 | Other | PA | FPH PROVIDER#-PSYCHIATRY |
| 1007540580073 | Medicaid | PA |
| Provider Name | Deanna J Fish-layton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497007462 PECOS PAC ID: 5597919860 Enrollment ID: I20130214000241 |
| Provider Name | Angela Jacobs |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144481425 PECOS PAC ID: 5698921344 Enrollment ID: I20170125001679 |
| Provider Name | Robin Sammons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164907226 PECOS PAC ID: 3274877121 Enrollment ID: I20181203003248 |
| Provider Name | Tammy Mcadoo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982246492 PECOS PAC ID: 7416383682 Enrollment ID: I20200206001286 |
| Provider Name | Nancy Laudermilch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265785125 PECOS PAC ID: 3072986157 Enrollment ID: I20230311000013 |
| Provider Name | Geoffrey A Gadow |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740357326 PECOS PAC ID: 7012350671 Enrollment ID: I20240210000177 |
| Provider Name | Desiree Nicole Hart |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871260869 PECOS PAC ID: 8729520903 Enrollment ID: I20240603003209 |
| Provider Name | Chloe Olivia Lunn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457011520 PECOS PAC ID: 7719422682 Enrollment ID: I20240820002907 |
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