| Susquehanna Counseling Group, Inc. | |
|
400 Third Ave. Park Office Bldg. Suite 212 Kingston PA 18704 | |
| (570) 283-1600 | |
| (570) 283-5515 |
| Full Name | Susquehanna Counseling Group, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 400 Third Ave., Kingston, Pennsylvania |
| Authorized Official Name and Position | John Shovlin (PRESIDENT) |
| Authorized Official Contact | 5702831600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susquehanna Counseling Group, Inc. 400 Third Ave. Park Office Bldg. Suite 212 Susquehanna Counseling Group Inc Kingston PA 18704 Ph: (570) 283-1600 | Susquehanna Counseling Group, Inc. 400 Third Ave. Park Office Bldg. Suite 212 Kingston PA 18704 Ph: (570) 283-1600 |
| NPI Number | 1790894749 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 06/19/2012 |
| Medicare PECOS PAC ID | 0547200263 |
|---|---|
| Medicare Enrollment ID | O20050511000859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790894749 | NPI | - | NPPES |
| SU539129 | Other | PA | BLUE CROSS GROUP # |
| 4657272 | Other | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PS006992L (Pennsylvania) | Primary |
| Provider Name | Kathleen Ann Atwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477653905 PECOS PAC ID: 6709826423 Enrollment ID: I20051221000144 |
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