Provider Demographics
NPI:1487651170
Name:BLOOMSBURG PSYCHOTHERAPY CENTER LLC
Entity Type:Organization
Organization Name:BLOOMSBURG PSYCHOTHERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-387-1832
Mailing Address - Street 1:816 CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8976
Mailing Address - Country:US
Mailing Address - Phone:570-387-1832
Mailing Address - Fax:570-387-5103
Practice Address - Street 1:816 CENTRAL RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8976
Practice Address - Country:US
Practice Address - Phone:570-387-1832
Practice Address - Fax:570-387-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103T00000X, 104100000X, 1041C0700X
PAPS007710L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty