Provider Demographics
NPI:1629183264
Name:HISPANIC AMERICAN ORGANIZATION
Entity Type:Organization
Organization Name:HISPANIC AMERICAN ORGANIZATION
Other - Org Name:HAO COUNSELING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:HOMI
Authorized Official - Last Name:KOTWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-435-5334
Mailing Address - Street 1:462 W WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102
Mailing Address - Country:US
Mailing Address - Phone:610-435-5334
Mailing Address - Fax:610-435-2331
Practice Address - Street 1:462 W WALNUT ST.
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-435-5334
Practice Address - Fax:610-435-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA206870261QM0801X
261QM0801X
PA212390261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001275120017Medicaid
PA1001275120004Medicaid
PA1001275120004Medicaid