Provider Demographics
NPI:1083695985
Name:SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT
Entity Type:Organization
Organization Name:SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT
Other - Org Name:UPMC WESTERN BEHAVIORAL HEALTH AT SAFE HARBOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCSW
Authorized Official - Phone:814-451-2232
Mailing Address - Street 1:1330 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1402
Practice Address - Country:US
Practice Address - Phone:814-459-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QM0801X, 251B00000X, 251S00000X, 261Q00000X, 101YP2500X, 103T00000X, 104100000X
PA414320261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
25-1317490OtherCIGNA
272785OtherHIGHMARK KHPW
25-1317490OtherAETNA
751231OtherHIGHMARK PAR W/ PREMIER
PA100751136Medicaid
751231OtherHIGHMARK PAR W/ INDEMNITY
A778081OtherVALUEOPTIONS
751231OtherHIGHMARK PAR W/ INDEMNITY
=========OtherVANTAGE
PA100751136Medicaid
25-1317490OtherAETNA
=========OtherMENTAL HEALTH NETWORK
=========OtherTRICARE
751231OtherHIGHMARK PAR W/ PREMIER