Healthcare Provider Details

I. General information

NPI: 1710779616
Provider Name (Legal Business Name): THE CENTER FOR CHILD PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 DAVIS ST
CLARKS SUMMIT PA
18411-1837
US

IV. Provider business mailing address

411 DAVIS ST
CLARKS SUMMIT PA
18411-1837
US

V. Phone/Fax

Practice location:
  • Phone: 570-319-6961
  • Fax:
Mailing address:
  • Phone: 570-319-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FAUVE ELIETH YOUNG-MORRISON
Title or Position: OWNER
Credential: PSY.D.
Phone: 570-319-6961