Provider Demographics
NPI:1093135964
Name:CONCERN PROFESSIONAL SERVICES FOR CHILDREN, YOUTH, & FAMILIES
Entity Type:Organization
Organization Name:CONCERN PROFESSIONAL SERVICES FOR CHILDREN, YOUTH, & FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WONNIE
Authorized Official - Suffix:
Authorized Official - Credentials:M ED,BSL
Authorized Official - Phone:215-421-4692
Mailing Address - Street 1:1 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1323
Mailing Address - Country:US
Mailing Address - Phone:610-944-0445
Mailing Address - Fax:
Practice Address - Street 1:69 MONTELLO RD
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1515
Practice Address - Country:US
Practice Address - Phone:484-706-1617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001706251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health