Provider Demographics
NPI:1558791863
Name:POCONO BEHAVIORAL WELLNESS, LLC
Entity Type:Organization
Organization Name:POCONO BEHAVIORAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/PRACTICE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-994-2664
Mailing Address - Street 1:745 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2060
Mailing Address - Country:US
Mailing Address - Phone:570-994-2664
Mailing Address - Fax:570-694-6694
Practice Address - Street 1:745 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2060
Practice Address - Country:US
Practice Address - Phone:570-994-2664
Practice Address - Fax:570-694-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA361620OtherMEDICARE PTAN