Healthcare Provider Details

I. General information

NPI: 1629106547
Provider Name (Legal Business Name): MENTORS RESOURCE & DEVELOPMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR H2 BOX 1016C EMERY RD
DINGMANS FERRY PA
18328
US

IV. Provider business mailing address

RR #2 BOX 1016C EMERY RD
DINGMANS FERRY PA
18328
US

V. Phone/Fax

Practice location:
  • Phone: 845-344-0392
  • Fax: 845-344-0392
Mailing address:
  • Phone: 845-344-0392
  • Fax: 845-344-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number95311
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS009154L
License Number StatePA

VIII. Authorized Official

Name: DR. JAY HERMAN JOERGER
Title or Position: PRES
Credential: EDD
Phone: 845-344-0392