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402 N Fulton St Allentown PA 18102-2002 | |
| (610) 432-3919 | |
| (610) 432-5174 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 402 N Fulton St, Allentown, Pennsylvania |
| Authorized Official Name and Position | Leslie Tenbroeck (VICE PRESIDENT) |
| Authorized Official Contact | 6107741434 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
402 N Fulton St Allentown PA 18102-2002 Ph: (610) 432-3919 | 402 N Fulton St Allentown PA 18102-2002 Ph: (610) 432-3919 |
| NPI Number | 1457536534 |
|---|---|
| Provider Enumeration Date | 01/08/2008 |
| Last Update Date | 11/17/2020 |
| Certification Date | 11/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457536534 | NPI | - | NPPES |
| 100759368 0013 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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