Provider Demographics
NPI:1821304544
Name:FORENSIC COUNSELING ASSOCIATES LLC
Entity Type:Organization
Organization Name:FORENSIC COUNSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTANZETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-460-4379
Mailing Address - Street 1:1385 POCONO BLVD.
Mailing Address - Street 2:FORENSIC COUNSELING ASSOCIATES, LLC
Mailing Address - City:MT. POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344
Mailing Address - Country:US
Mailing Address - Phone:570-460-4379
Mailing Address - Fax:570-421-3600
Practice Address - Street 1:1385 POCONO BLVD.
Practice Address - Street 2:FORENSIC COUNSELING ASSOCIATES, LLC
Practice Address - City:MT. POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344
Practice Address - Country:US
Practice Address - Phone:570-460-4379
Practice Address - Fax:570-421-3600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORENSIC COUNSELING ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-19
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102550736Medicaid