Provider Demographics
NPI:1043450455
Name:METHODIST SERVICES FOR CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:METHODIST SERVICES FOR CHILDREN AND FAMILIES
Other - Org Name:COMMUNITY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:610-588-9109
Mailing Address - Street 1:400 NORTHAMPTON ST
Mailing Address - Street 2:SUITE 607
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3543
Mailing Address - Country:US
Mailing Address - Phone:610-252-2000
Mailing Address - Fax:610-588-5016
Practice Address - Street 1:51 MARKET ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1901
Practice Address - Country:US
Practice Address - Phone:610-588-9109
Practice Address - Fax:610-588-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA214210251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001534600007Medicaid