Healthcare Provider Details

I. General information

NPI: 1376912923
Provider Name (Legal Business Name): TELEMENTAL HEALTH NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S GREENWOOD AVE
EASTON PA
18045-9800
US

IV. Provider business mailing address

650 S GREENWOOD AVE
EASTON PA
18045-9800
US

V. Phone/Fax

Practice location:
  • Phone: 484-245-4455
  • Fax:
Mailing address:
  • Phone: 484-245-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRITTANY AZZOLINA
Title or Position: OWNER
Credential: LPC
Phone: 484-245-4455