Provider Demographics
NPI:1629106547
Name:MENTORS RESOURCE & DEVELOPMENT CORP
Entity Type:Organization
Organization Name:MENTORS RESOURCE & DEVELOPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:JOERGER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:845-344-0392
Mailing Address - Street 1:RR #2 BOX 1016C
Mailing Address - Street 2:EMERY RD
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328
Mailing Address - Country:US
Mailing Address - Phone:845-344-0392
Mailing Address - Fax:845-344-0392
Practice Address - Street 1:RR H2 BOX 1016C
Practice Address - Street 2:EMERY RD
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328
Practice Address - Country:US
Practice Address - Phone:845-344-0392
Practice Address - Fax:845-344-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY95311103TC1900X
PAPS009154L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV6B211Medicare ID - Type Unspecified
PA063335Medicare ID - Type Unspecified