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NPI Code Detail

MEDICARE: CARBON LEHIGH INTERMEDIATE #21

MEDICARE: CARBON LEHIGH INTERMEDIATE #21
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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

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

General Provider Information

NPI Number : 1205050945
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARBON LEHIGH INTERMEDIATE #21
Provider Business Mailing Address
First Line : 4210 INDEPENDENCE DRIVE
Second Line :
City : SCHNECKSVILLE
State : PA
Zip : 18078-2580
Country : US
Telephone Number : 610-769-4111
Fax Number : 610-769-1250
Provider Business Practice Location Address
First Line : 770 STATE RD
Second Line :
City : LEHIGHTON
State : PA
Zip : 18235-2857
Country : US
Telephone Number : 610-769-4111
Fax Number : 610-769-1168
Authorized Official
Title or Position : DIRECTOR
Name : MR. MARK SCOTT
Credential : PSY D
Telephone Number : 610-769-4111
Provider Enumeration Date : 04/12/2007
Last Update Date : 02/27/2023

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