Healthcare Provider Details

I. General information

NPI: 1497159784
Provider Name (Legal Business Name): CMSU BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 BLOOM RD SUITE # 1
DANVILLE PA
17821-8506
US

IV. Provider business mailing address

PO BOX 219
DANVILLE PA
17821-0219
US

V. Phone/Fax

Practice location:
  • Phone: 570-275-6080
  • Fax: 570-275-6089
Mailing address:
  • Phone: 570-275-5422
  • Fax: 570-275-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD DELOS BEACH
Title or Position: ADMINISTRATOR
Credential: LCSW
Phone: 570-275-5422