Provider Demographics
NPI:1891093001
Name:MENTAL HEALTH ASSOCIATES OF NORTH CENTRAL PA
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATES OF NORTH CENTRAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CASSELBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-265-2525
Mailing Address - Street 1:21 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1803
Mailing Address - Country:US
Mailing Address - Phone:570-265-2525
Mailing Address - Fax:570-265-1075
Practice Address - Street 1:MAIN AND KING STREET
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:PA
Practice Address - Zip Code:18626
Practice Address - Country:US
Practice Address - Phone:570-265-2525
Practice Address - Fax:570-265-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center