Provider Demographics
NPI:1477626992
Name:CHILDRENS CENTER FOR TREATMENT AND EDUCATION
Entity Type:Organization
Organization Name:CHILDRENS CENTER FOR TREATMENT AND EDUCATION
Other - Org Name:BEACON LIGHT BEHAVIORAL HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-368-3800
Mailing Address - Street 1:800 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3278
Mailing Address - Country:US
Mailing Address - Phone:814-362-5250
Mailing Address - Fax:814-362-2185
Practice Address - Street 1:800 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3278
Practice Address - Country:US
Practice Address - Phone:814-362-5248
Practice Address - Fax:814-362-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004950101YP2500X
PAPS016644103TC0700X
PASW126127104100000X
PACW0163161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001989164OtherHIGHMARK - NON MANAGED CARE
PA001989165OtherHIGHMARK- MANAGED CARE
PA1007710210049Medicaid
PA001989164OtherHIGHMARK - NON MANAGED CARE