Provider Demographics
NPI:1619105350
Name:MENTAL HEALTH ASSOCIATION OF NORTHWESTERN PA
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF NORTHWESTERN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-465-4462
Mailing Address - Street 1:1101 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1839
Mailing Address - Country:US
Mailing Address - Phone:814-465-4462
Mailing Address - Fax:814-459-8833
Practice Address - Street 1:1101 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1839
Practice Address - Country:US
Practice Address - Phone:814-465-4462
Practice Address - Fax:814-459-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102267020OtherPROMISE ID