Provider Demographics
NPI:1790101798
Name:WYOMING COUNTY SPECIAL NEEDS ASSOCIATION
Entity Type:Organization
Organization Name:WYOMING COUNTY SPECIAL NEEDS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:570-996-6222
Mailing Address - Street 1:636 SR 29 N
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-7113
Mailing Address - Country:US
Mailing Address - Phone:570-996-6222
Mailing Address - Fax:570-996-6223
Practice Address - Street 1:636 SR 29 N
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7113
Practice Address - Country:US
Practice Address - Phone:570-996-6222
Practice Address - Fax:570-996-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health