| Wise Mind Therapeutic Services Llc | |
|
1103 Rocky Rd Ste 202 West Lawn PA 19609-1166 | |
| (484) 641-8098 | |
| (610) 750-5329 |
| Full Name | Wise Mind Therapeutic Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1103 Rocky Rd Ste 202, West Lawn, Pennsylvania |
| Authorized Official Name and Position | Diane Lillington (OWNER) |
| Authorized Official Contact | 4846418098 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wise Mind Therapeutic Services Llc 1103 Rocky Rd Ste 202 West Lawn PA 19609-1166 Ph: (484) 640-8098 | Wise Mind Therapeutic Services Llc 1103 Rocky Rd Ste 202 West Lawn PA 19609-1166 Ph: (484) 641-8098 |
| NPI Number | 1275239592 |
|---|---|
| Provider Enumeration Date | 02/07/2023 |
| Last Update Date | 03/08/2023 |
| Certification Date | 03/08/2023 |
| Medicare PECOS PAC ID | 6901270164 |
|---|---|
| Medicare Enrollment ID | O20230330000498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275239592 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Diane Y Lillington |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356724603 PECOS PAC ID: 1254705411 Enrollment ID: I20230330000667 |
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