Provider Demographics
NPI:1710432844
Name:T W PONESSA
Entity Type:Organization
Organization Name:T W PONESSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONESSA
Authorized Official - Suffix:
Authorized Official - Credentials:EED, MS
Authorized Official - Phone:717-560-7917
Mailing Address - Street 1:725 CORTLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4124
Mailing Address - Country:US
Mailing Address - Phone:717-758-5935
Mailing Address - Fax:
Practice Address - Street 1:725 CORTLEIGH DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4124
Practice Address - Country:US
Practice Address - Phone:717-758-5935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125120251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health