Provider Demographics
NPI:1124187364
Name:NORTHEAST COUNSELING ASSOCIATES, INC.
Entity Type:Organization
Organization Name:NORTHEAST COUNSELING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-253-9323
Mailing Address - Street 1:403A SPINNER RD
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-7634
Mailing Address - Country:US
Mailing Address - Phone:570-253-9323
Mailing Address - Fax:570-253-6050
Practice Address - Street 1:403A SPINNER RD
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-7634
Practice Address - Country:US
Practice Address - Phone:570-253-9323
Practice Address - Fax:570-253-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0126501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018862000006Medicaid
PA067901Medicare ID - Type Unspecified