Healthcare Provider Details

I. General information

NPI: 1396051017
Provider Name (Legal Business Name): SALESIAN MONASTIC COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 BOX 455 FRANTZ ROAD
BRODHEADSVILLE PA
18322-9630
US

IV. Provider business mailing address

HC 1 BOX 455 FRANTZ ROAD
BRODHEADSVILLE PA
18322-9630
US

V. Phone/Fax

Practice location:
  • Phone: 570-992-3448
  • Fax:
Mailing address:
  • Phone: 570-992-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005430L
License Number StatePA

VIII. Authorized Official

Name: DR. BERNARD SEIF
Title or Position: ABBOT PRESIDENT
Credential: EDD DNM
Phone: 570-992-3448