Provider Demographics
NPI:1073210803
Name:COLLABORATIVE MENTAL WELLNESS
Entity Type:Organization
Organization Name:COLLABORATIVE MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DURONN
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:717-421-7629
Mailing Address - Street 1:940 E PARK DR STE 206
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2800
Mailing Address - Country:US
Mailing Address - Phone:717-421-7629
Mailing Address - Fax:
Practice Address - Street 1:940 E PARK DR STE 206
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2800
Practice Address - Country:US
Practice Address - Phone:717-421-7629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1942835327Medicaid