Provider Demographics
NPI:1770833535
Name:COLONIAL INTERMEDIATE UNIT 20
Entity Type:Organization
Organization Name:COLONIAL INTERMEDIATE UNIT 20
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-515-6403
Mailing Address - Street 1:6 DANFORTH DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-7899
Mailing Address - Country:US
Mailing Address - Phone:610-555-5550
Mailing Address - Fax:610-515-6457
Practice Address - Street 1:6 DANFORTH DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-7899
Practice Address - Country:US
Practice Address - Phone:610-555-5550
Practice Address - Fax:610-515-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA224320261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health