Provider Demographics
NPI:1073873485
Name:KEYSTONE RENAISSANCE FAMILY SERVICES
Entity Type:Organization
Organization Name:KEYSTONE RENAISSANCE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:REINHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-702-8500
Mailing Address - Street 1:215 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-9208
Mailing Address - Country:US
Mailing Address - Phone:570-702-8500
Mailing Address - Fax:570-702-8575
Practice Address - Street 1:215 HICKORY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-9208
Practice Address - Country:US
Practice Address - Phone:570-702-8500
Practice Address - Fax:570-702-8575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAISSANCE PSYCHOLOGICAL AND COUNSELING CORPORATIOM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-18
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003830L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty