Provider Demographics
NPI:1295746451
Name:FAMILY SERVICES OF WARREN COUNTY, INC.
Entity type:Organization
Organization Name:FAMILY SERVICES OF WARREN COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-723-1330
Mailing Address - Street 1:589 HOSPITAL DR
Mailing Address - Street 2:E
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4875
Mailing Address - Country:US
Mailing Address - Phone:814-723-1330
Mailing Address - Fax:
Practice Address - Street 1:589 HOSPITAL DR
Practice Address - Street 2:E
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4875
Practice Address - Country:US
Practice Address - Phone:814-723-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005684L103T00000X
104100000X, 1041C0700X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007320880002Medicaid
PA1007320880001Medicaid
PA1007320880002Medicaid