Provider Demographics
NPI:1457684896
Name:CENTRAL SUSQUEHANNA INTERMEDIATE UNIT
Entity Type:Organization
Organization Name:CENTRAL SUSQUEHANNA INTERMEDIATE UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:WITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-523-1155
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-0213
Mailing Address - Country:US
Mailing Address - Phone:570-523-1155
Mailing Address - Fax:570-524-7104
Practice Address - Street 1:801 SUSQUEHANNA AVE
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-1349
Practice Address - Country:US
Practice Address - Phone:570-988-1840
Practice Address - Fax:570-988-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA327430261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health