Provider Demographics
NPI:1720429608
Name:RAICES PASTORAL COUNSELING AND HUMAN DEVELOPMENT CENTER, INC
Entity Type:Organization
Organization Name:RAICES PASTORAL COUNSELING AND HUMAN DEVELOPMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:EDGARDO
Authorized Official - Last Name:JUAREZ MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-253-6588
Mailing Address - Street 1:512 HAMILTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1505
Mailing Address - Country:US
Mailing Address - Phone:267-253-6588
Mailing Address - Fax:
Practice Address - Street 1:512 HAMILTON ST STE 200
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1505
Practice Address - Country:US
Practice Address - Phone:267-253-6588
Practice Address - Fax:484-221-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)