Provider Demographics
NPI:1518918689
Name:ST. MICHAEL'S SCHOOL
Entity Type:Organization
Organization Name:ST. MICHAEL'S SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GITLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-388-6155
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:HOBAN HEIGHTS
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-0370
Mailing Address - Country:US
Mailing Address - Phone:570-388-6155
Mailing Address - Fax:570-388-6979
Practice Address - Street 1:HOBAN HEIGHTS
Practice Address - Street 2:BOX 370
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-0370
Practice Address - Country:US
Practice Address - Phone:570-388-6155
Practice Address - Fax:570-388-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007624250003Medicaid