Provider Demographics
NPI:1184617631
Name:POCONOS CENTER FOR PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:POCONOS CENTER FOR PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/PCPS
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-226-6499
Mailing Address - Street 1:1258 PURDYTOWN TPKE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18438-6793
Mailing Address - Country:US
Mailing Address - Phone:570-226-1963
Mailing Address - Fax:570-226-1967
Practice Address - Street 1:1258 PURDYTOWN TPKE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18438-6793
Practice Address - Country:US
Practice Address - Phone:570-226-1963
Practice Address - Fax:570-226-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012087310001Medicaid