Provider Demographics
NPI:1346440542
Name:MOSES TAYLOR HOSPITAL WORKLIFE AND COUNSELING SERVICES
Entity Type:Organization
Organization Name:MOSES TAYLOR HOSPITAL WORKLIFE AND COUNSELING SERVICES
Other - Org Name:ELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BROLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, CEAP
Authorized Official - Phone:570-340-2147
Mailing Address - Street 1:700 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1724
Mailing Address - Country:US
Mailing Address - Phone:570-340-2147
Mailing Address - Fax:570-340-2150
Practice Address - Street 1:1141 CLAY AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18510-1191
Practice Address - Country:US
Practice Address - Phone:570-340-2147
Practice Address - Fax:570-340-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW00248L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty