Healthcare Provider Details

I. General information

NPI: 1477626992
Provider Name (Legal Business Name): CHILDRENS CENTER FOR TREATMENT AND EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E MAIN ST
BRADFORD PA
16701-3278
US

IV. Provider business mailing address

800 E MAIN ST
BRADFORD PA
16701-3278
US

V. Phone/Fax

Practice location:
  • Phone: 814-362-5248
  • Fax: 814-362-5263
Mailing address:
  • Phone: 814-362-5250
  • Fax: 814-362-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004950
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016644
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW126127
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016316
License Number StatePA

VIII. Authorized Official

Name: MR. RICHARD SEAGER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 814-368-3800