Provider Demographics
NPI:1710617857
Name:CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INC
Entity Type:Organization
Organization Name:CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PISARCIK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:570-825-6425
Mailing Address - Street 1:335 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3808
Mailing Address - Country:US
Mailing Address - Phone:570-825-6425
Mailing Address - Fax:570-762-9013
Practice Address - Street 1:335 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3808
Practice Address - Country:US
Practice Address - Phone:570-825-6425
Practice Address - Fax:570-762-9013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty