MEDICARE: CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	222440	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013438878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES

Provider Business Mailing Address
First Line	:	1 W MAIN ST
Second Line	:
City	:	FLEETWOOD
State	:	PA
Zip	:	19522-1323
Country	:	US
Telephone Number	:	610-944-0445
Fax Number	:

Provider Business Practice Location Address
First Line	:	73 W WELLSBORO ST
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1412
Country	:	US
Telephone Number	:	610-944-0445
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GORDON MAY
Credential	:
Telephone Number	:	610-944-0445

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	07/03/2017

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