Provider Demographics
NPI:1649221219
Name:CATHOLIC SOCIAL SERVICES, INC.
Entity Type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:570-829-3489
Mailing Address - Street 1:33 E NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-2406
Mailing Address - Country:US
Mailing Address - Phone:570-829-3489
Mailing Address - Fax:570-829-7781
Practice Address - Street 1:33 E NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-2406
Practice Address - Country:US
Practice Address - Phone:570-829-3489
Practice Address - Fax:570-829-7781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC SOCIAL SERVICES, INC..
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-16
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 104100000X, 1041C0700X
PA1007592970013251S00000X
PA1007592970001251S00000X
PA1007592970017251S00000X
PA1007592970007251S00000X
PA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007592970013Medicaid
PA2100928OtherCIGNA BEHAVIORL HEALTH
PA999017OtherBC/BS OF NEPA
PA803427OtherFIRST PRIORITY HEALTH
PA000317559OtherBLUE SHIELD
PACA735872Medicare PIN