Provider Demographics
NPI:1568656908
Name:KALEIDASCOPE INC
Entity Type:Organization
Organization Name:KALEIDASCOPE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:REARDON
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:814-824-4515
Mailing Address - Street 1:4934 PEACH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2043
Mailing Address - Country:US
Mailing Address - Phone:814-824-4515
Mailing Address - Fax:814-824-4533
Practice Address - Street 1:4934 PEACH ST FL 2
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2043
Practice Address - Country:US
Practice Address - Phone:814-824-4515
Practice Address - Fax:814-824-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251B00000X, 251C00000X, 251S00000X
PAPS006926L103T00000X
PAMF000031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty