Provider Demographics
NPI:1891763249
Name:JEFFERSON REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:JEFFERSON REGIONAL MEDICAL CENTER
Other - Org Name:JEFFERSON HOSPITAL COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5861
Mailing Address - Street 1:810 CLAIRTON BLVD STE 500600
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-5505
Mailing Address - Country:US
Mailing Address - Phone:412-650-1100
Mailing Address - Fax:412-650-1101
Practice Address - Street 1:810 CLAIRTON BLVD STE 500600
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-5505
Practice Address - Country:US
Practice Address - Phone:412-650-1100
Practice Address - Fax:412-650-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007443470003Medicaid
PA401459Medicare ID - Type UnspecifiedCOUNSELING CENTER