Provider Demographics
NPI:1659594554
Name:THE WILLOWBROOK CENTER
Entity Type:Organization
Organization Name:THE WILLOWBROOK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BERGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-535-8586
Mailing Address - Street 1:422 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1824
Mailing Address - Country:US
Mailing Address - Phone:814-535-8586
Mailing Address - Fax:
Practice Address - Street 1:422 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1824
Practice Address - Country:US
Practice Address - Phone:814-535-8586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health