Provider Demographics
NPI:1164579298
Name:FAMILY SERVICE ASSOCIATION OF NORTHEASTERN PENNSYLVANIA
Entity Type:Organization
Organization Name:FAMILY SERVICE ASSOCIATION OF NORTHEASTERN PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GURNARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-823-5144
Mailing Address - Street 1:31 WEST MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701
Mailing Address - Country:US
Mailing Address - Phone:570-823-5144
Mailing Address - Fax:570-829-5054
Practice Address - Street 1:31 WEST MARKET STREET
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701
Practice Address - Country:US
Practice Address - Phone:570-823-5144
Practice Address - Fax:570-829-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009186950003Medicaid
PA0009186950003Medicaid